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Sample records for infectious varicella zoster

  1. Subclinical Shed of Infectious Varicella zoster Virus in Astronauts

    NASA Technical Reports Server (NTRS)

    Cohrs, Randall J.; Mehta, Satish K.; Schmid, D. Scott; Gilden, Donald H.; Pierson, Duane L.

    2007-01-01

    Aerosol borne varicella zoster virus (VZV) enters the nasopharynx and replicates in tonsillar T-cells, resulting in viremia and varicella (chickenpox). Virus then becomes latent in cranial nerve, dorsal root and autonomic nervous system ganglia along the entire neuraxis (1). Decades later, as cell-mediated immunity to VZV declines (4), latent VZV can reactivate to produce zoster (shingles). Infectious VZV is present in patients with varicella or zoster, but shed of infectious virus in the absence of disease has not been shown. We previously detected VZV DNA in saliva of astronauts during and shortly after spaceflight, suggesting stress induced subclinical virus reactivation (3). We show here that VZV DNA as well as infectious virus in present in astronaut saliva. VZV DNA was detected in saliva during and after a 13-day spaceflight in 2 of 3 astronauts (Fig. panel A). Ten days before liftoff, there was a rise in serum anti-VZV antibody in subjects 1 and 2, consistent with virus reactivation. In subject 3, VZV DNA was not detected in saliva, and there was no rise in anti-VZV antibody titer. Subject 3 may have been protected from virus reactivation by having zoster <10 years ago, which provides a boost in cell-medicated immunity to VZV (2). No VZV DNA was detected in astronaut saliva months before spaceflight, or in saliva of 10 age/sex-matched healthy control subjects sampled on alternate days for 3 weeks (88 saliva samples). Saliva taken 2-6 days after landing from all 3 subjects was cultured on human fetal lung cells (Fig. panel B). Infectious VZV was recovered from saliva of subjects 1 and 2 on the second day after landing. Virus specificity was confirmed by antibody staining and DNA analysis which showed it to be VZV of European descent, common in the US (5). Further, both antibody staining and DNA PCR demonstrated that no HSV-1 was detected in any infected culture. This is the first report of infectious VZV shedding in the absence of clinical disease

  2. Complications of varicella zoster.

    PubMed

    Gücüyener, Kivilcim; Citak, Elvan Cağlar; Elli, Murat; Serdaroğlu, Ayse; Citak, Funda Erkasar

    2002-02-01

    Primary infection with varicella zoster is characterzed by a generalized vesicular rash usually without significant systemic illness. Encephalitis, pneumonitis, pancreatitis, nephritis, Reye and Guillan-Barre syndrome transvers myelitis, myocarditis have been reported before, but there is not any case having all these system to be involved during the same infection in a sequential manner ending up with multiorgan failure. We wanted to represent 21-month-old boy had a multiorgan failure due to varicella zoster infection. PMID:11929039

  3. Varicella-zoster virus.

    PubMed Central

    Arvin, A M

    1996-01-01

    Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins. VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates. Primary VZV infection elicits immunoglobulin G (IgG), IgM, and IgA antibodies, which bind to many classes of viral proteins. Virus-specific cellular immunity is critical for controlling viral replication in healthy and immunocompromised patients with primary or recurrent VZV infections. Rapid laboratory confirmation of the diagnosis of varicella or herpes zoster, which can be accomplished by detecting viral proteins or DNA, is important to determine the need for antiviral therapy. Acyclovir is licensed for treatment of varicella and herpes zoster, and acyclovir, valacyclovir, and famciclovir are approved for herpes zoster. Passive antibody prophylaxis with varicella-zoster immune globulin is indicated for susceptible high-risk patients exposed to varicella. A live attenuated varicella vaccine (Oka/Merck strain) is now recommended for routine childhood immunization. PMID:8809466

  4. Varicella zoster virus infection.

    PubMed

    Gershon, Anne A; Breuer, Judith; Cohen, Jeffrey I; Cohrs, Randall J; Gershon, Michael D; Gilden, Don; Grose, Charles; Hambleton, Sophie; Kennedy, Peter G E; Oxman, Michael N; Seward, Jane F; Yamanishi, Koichi

    2015-01-01

    Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs. Reactivation of the virus leads to virus replication, which causes zoster (shingles) in tissues innervated by the involved neurons, inflammation and cell death - a process that can lead to persistent radicular pain (postherpetic neuralgia). The pathogenesis of postherpetic neuralgia is unknown and it is difficult to treat. Furthermore, other zoster complications can develop, including myelitis, cranial nerve palsies, meningitis, stroke (vasculopathy), retinitis, and gastroenterological infections such as ulcers, pancreatitis and hepatitis. VZV is the only human herpesvirus for which highly effective vaccines are available. After varicella or vaccination, both wild-type and vaccine-type VZV establish latency, and long-term immunity to varicella develops. However, immunity does not protect against reactivation. Thus, two vaccines are used: one to prevent varicella and one to prevent zoster. In this Primer we discuss the pathogenesis, diagnosis, treatment, and prevention of VZV infections, with an emphasis on the molecular events that regulate these diseases. For an illustrated summary of this Primer, visit: http://go.nature.com/14xVI1. PMID:27188665

  5. Varicella Zoster Complications

    PubMed Central

    Nagel, Maria A.; Gilden, Don

    2013-01-01

    Opinion statement Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which virus becomes latent in ganglionic neurons along the entire neuraxis. With advancing age or immunosuppression, cell-mediated immunity to VZV declines and virus reactivates to cause zoster (shingles), which can occur anywhere on the body. Skin lesions resolve within 1-2 weeks, while complete cessation of pain usually takes 4-6 weeks. Zoster can be followed by chronic pain (postherpetic neuralgia), cranial nerve palsies, zoster paresis, meningoencephalitis, cerebellitis, myelopathy, multiple ocular disorders and vasculopathy that can mimic giant cell arteritis. All of the neurological and ocular disorders listed above may also develop without rash. Diagnosis of VZV-induced neurological disease may require examination of CSF, serum and/ or ocular fluids. In the absence of rash in a patient with neurological disease potentially due to VZV, CSF should be examined for VZV DNA by PCR and for anti-VZV IgG and IGM. Detection of VZV IgG antibody in CSF is superior to detection of VZV DNA in CSF to diagnose vasculopathy, recurrent myelopathy, and brainstem encephalitis. Oral antiviral drugs speed healing of rash and shorten acute pain. Immunocompromised patients require intravenous acyclovir. First-line treatments for post-herpetic neuralgia include tricyclic antidepressants gabapentin, pregabalin, and topical lidocaine patches. VZV vasculopathy, meningoencephalitis, and myelitis are all treated with intravenous acyclovir. PMID:23794213

  6. Varicella zoster virus latency

    PubMed Central

    Eshleman, Emily; Shahzad, Aamir; Cohrs, Randall J

    2011-01-01

    Primary infection by varicella zoster virus (VZV) typically results in childhood chickenpox, at which time latency is established in the neurons of the cranial nerve, dorsal root and autonomic ganglia along the entire neuraxis. During latency, the histone-associated virus genome assumes a circular episomal configuration from which transcription is epigenetically regulated. The lack of an animal model in which VZV latency and reactivation can be studied, along with the difficulty in obtaining high-titer cell-free virus, has limited much of our understanding of VZV latency to descriptive studies of ganglia removed at autopsy and analogy to HSV-1, the prototype alphaherpesvirus. However, the lack of miRNA, detectable latency-associated transcript and T-cell surveillance during VZV latency highlight basic differences between the two neurotropic herpesviruses. This article focuses on VZV latency: establishment, maintenance and reactivation. Comparisons are made with HSV-1, with specific attention to differences that make these viruses unique human pathogens. PMID:21695042

  7. Subclinical Reactivation and Shed of Infectious Varicella Zoster Virus in Saliva of Astronauts

    NASA Technical Reports Server (NTRS)

    Cohrs, Randall J.; Mehta, Satish K.; Schmid, D. Scott; Gilden, Donald H.; Pierson, Duane L.

    2007-01-01

    We have previously detected VZV in healthy astronauts both during spaceflight and shortly after landing. Herein, we show that VZV shed in seropositive astronauts is infectious. A total of 40 saliva samples were obtained from each of the 3 astronauts. From each astronaut, 14 samples were taken 109 to 133 days before liftoff, 1 sample was taken every day during 12 days in space, and one sample was taken for 14 consecutive days beginning the second day after landing. Quantitative PCR was used to detect VZV DNA in saliva. None of 42 preflight saliva samples contained VZV DNA. VZV DNA was detected in saliva from 2 of 3 astronauts. In 1 astronaut, 6 of 12 samples obtained during space flight contained 120 to 2,500 copies of VZV DNA per ml; after landing, 1250 copies of VZV DNA were present on day 2, 45 copies on day 3, and 110 copies on day 5. All samples taken 6 to 15 days after touchdown were negative for VZV DNA. In the second astronaut, 5 of 12 samples obtained during space flight contained 18 to 650 copies of VZV DNA per ml; after landing, 560 copies of VZV DNA were present in saliva on day 2, 340 copies on day 4, 45 copies on day 5, and 23 copes on day 6. All samples taken 7 to 15 days after touchdown were negative for VZV DNA. Saliva taken 2 to 6 days after landing from all 3 astronauts was cultured on human fetal lung cells. After one subcultivation, a cytopathic effect developed in cultures inoculated with saliva from the two astronauts whose saliva contained VZV DNA. Both PCR and immunostaining identified the isolates to be VZV and not HSV-1. Importantly, the astronaut in whom no VZV was detected had a history of zoster 9 years earlier. It is possible that a boost in cell-mediated immunity to VZV which is known to develop after zoster protected him from subclinical reactivation. The genotype of the two VZV isolates was determined by VZV ORF22-based PCR/sequencing along with FRET-based PCR assays that target specific nucleotide polymorphisms. Both VZV isolates

  8. Varicella-zoster virus: pathogenesis, incidence patterns and vaccination programs.

    PubMed

    Gabutti, Giovanni; Franchi, Michele; Maniscalco, Licia; Stefanati, Armando

    2016-06-01

    Varicella or chickenpox is a common and highly contagious exanthematic disease caused by the varicella-zoster virus (VZV) that during primary infection has the ability to establish latency. VZV reactivation, even decades after primary infection, causes herpes zoster. In healthy immunocompetent subjects, children in particular, varicella results in mild to moderate illness and for this reason, regardless its high morbidity, it is not considered a public health priority. Varicella still represents the most widespread vaccine preventable childhood infectious disease in industrialized countries; due to its relevant burden on healthcare resources several countries has introduced varicella vaccination into the recommended routine childhood national immunization schedule. Nowadays, live attenuated monovalent and combined MMRV vaccines are licensed worldwide. The use of several millions of doses has demonstrated the excellent safety and efficacy level of varicella vaccines as well as of combined MMRV vaccines. Universal vaccination adopted in many countries with a two-dose strategy has allowed to significantly reducing morbidity and mortality of this infectious disease. Anyway, an ample international debate is ongoing on the time range to be used between the two doses, and on the safety issues related to the use as first-dose of MMRV vaccine. Taking into account the availability of a zoster vaccine in subjects older than 50 years of age, it will be relevant to clarify if an impact on exogenous boosters and on the epidemiology of herpes zoster can occur after the adoption of extensive varicella immunization. PMID:27125440

  9. Varicella Zoster Virus Immune Evasion Strategies

    PubMed Central

    Kinchington, Paul R.; Slobedman, Barry

    2014-01-01

    The capacity of varicella zoster virus (VZV) to cause varicella (chickenpox) relics upon multiple steps, beginning with inoculation of the host at mucosal sites with infectious virus in respiratory droplets. Despite the presence of a powerful immune defense system, this virus is able to disseminate from the site of initial infection to multiple sites, resulting in the emergence of distinctive cutaneous vesiculopustular lesions. Most recently, it has been proposed that the steps leading to cutaneous infection include VZV infecting human tonsillar CD4+ T cells that express skin homing markers that allow them to transport VZV directly from the lymph node to the skin during the primary viremia. It has also been proposed that dendritic cells (DC) of the respiratory mucosa may be among the first cells to encounter VZV and these cells may transport virus to the draining lymph node. These various virus-host cell interactions would all need to occur in the face of an intact host immune response for the virus to successfully cause disease. Significantly, following primary exposure to VZV, there is a prolonged incubation period before emergence of skin lesions, during which time the adaptive immune response is delayed. For these reasons, it has been proposed that VZV must encode functions which benefit the virus by evading the immune response. This chapter will review the diverse array of immunomodulatory mechanisms identified to date that VZV has evolved to at least transiently limit immune recognition. PMID:20563710

  10. Varicella Zoster Virus in the Nervous System

    PubMed Central

    Gilden, Don; Nagel, Maria; Cohrs, Randall; Mahalingam, Ravi; Baird, Nicholas

    2015-01-01

    Varicella zoster virus (VZV) is a ubiquitous, exclusively human alphaherpesvirus. Primary infection usually results in varicella (chickenpox), after which VZV becomes latent in ganglionic neurons along the entire neuraxis. As VZV-specific cell-mediated immunity declines in elderly and immunocompromised individuals, VZV reactivates and causes herpes zoster (shingles), frequently complicated by postherpetic neuralgia. VZV reactivation also produces multiple serious neurological and ocular diseases, such as cranial nerve palsies, meningoencephalitis, myelopathy, and VZV vasculopathy, including giant cell arteritis, with or without associated rash. Herein, we review the clinical, laboratory, imaging, and pathological features of neurological complications of VZV reactivation as well as diagnostic tests to verify VZV infection of the nervous system. Updates on the physical state of VZV DNA and viral gene expression in latently infected ganglia, neuronal, and primate models to study varicella pathogenesis and immunity are presented along with innovations in the immunization of elderly individuals to prevent VZV reactivation. PMID:26918131

  11. The epidemiology of Varicella Zoster Virus infection in Italy

    PubMed Central

    Gabutti, Giovanni; Rota, Maria C; Guido, Marcello; De Donno, Antonella; Bella, Antonino; Ciofi degli Atti, Marta L; Crovari, Pietro

    2008-01-01

    Background The epidemiological importance of varicella and zoster and the availability of an efficacious and safe vaccine have led to an important international debate regarding the suitability of mass vaccination. The objective of the study was to describe the epidemiology of varicella and zoster in Italy and to determine whether there have been changes with respect to observations provided by an analogous study conducted 8 years ago, in order to define the most appropriate vaccination strategy. Methods A number of data sources were evaluated, a cross-sectional population-based seroprevalence study was conducted on samples collected in 2004, and the results were compared with data obtained in 1996. Results The data from active and passive surveillance systems confirm that varicella is a widespread infectious disease which mainly affects children. VZV seroprevalence did not substantially differ from that found in the previous study. The sero-epidemiological profile in Italy is different from that in other European countries. In particular, the percentage of susceptible adolescents is at least nearly twice as high as in other European countries and in the age group 20–39 yrs, approximately 9% of individuals are susceptible to VZV. Conclusion The results of this study can contribute to evaluating the options for varicella vaccination. It is possible that in a few years, in all Italian Regions, there will exist the conditions necessary for implementing a mass vaccination campaign and that the large-scale availability of MMRV tetravalent vaccines will facilitate mass vaccination. PMID:18954432

  12. Disseminated varicella-zoster virus in an immunocompetent adult.

    PubMed

    Petrun, Branden; Williams, Victoria; Brice, Sylvia

    2015-03-01

    Varicella-zoster is the virus that causes varicella (chicken pox), herpes zoster (shingles), and rarely, severe disseminated disease including diffuse rash, encephalitis, hepatitis, and pneumonitis. Disseminated disease is most often seen in immunocompromised patients. We describe a case of disseminated zoster in an immunocompentent patient who had previously been immune to VZV. This case is also unusual in that his clinical presentation was most consistent with varicella while his laboratory data was most consistent with herpes zoster. For the purpose of rapid diagnosis and initiation of appropriate therapy, clinicians should be aware of these more atypical presentations of VZV infection. PMID:25780980

  13. The neurobiology of varicella zoster virus infection

    PubMed Central

    Gilden, D.; Mahalingam, R.; Nagel, M. A.; Pugazhenthi, S.; Cohrs, R. J.

    2011-01-01

    Varicella zoster virus (VZV) is a neurotropic herpesvirus that infects nearly all humans. Primary infection usually causes chickenpox (varicella), after which virus becomes latent in cranial nerve ganglia, dorsal root ganglia and autonomic ganglia along the entire neuraxis. Although VZV cannot be isolated from human ganglia, nucleic acid hybridization and, later, polymerase chain reaction proved that VZV is latent in ganglia. Declining VZV-specific host immunity decades after primary infection allows virus to reactivate spontaneously, resulting in shingles (zoster) characterized by pain and rash restricted to 1-3 dermatomes. Multiple other serious neurological and ocular disorders also result from VZV reactivation. This review summarizes the current state of knowledge of the clinical and pathological complications of neurological and ocular disease produced by VZV reactivation, molecular aspects of VZV latency, VZV virology and VZV-specific immunity, the role of apoptosis in VZV-induced cell death, and the development of an animal model provided by simian varicella virus infection of monkeys. PMID:21342215

  14. Developments in Varicella Zoster Virus Vasculopathy.

    PubMed

    Nagel, Maria A; Gilden, Don

    2016-02-01

    Varicella zoster virus (VZV) is a highly neurotropic human herpesvirus. Primary infection usually causes varicella (chicken pox), after which virus becomes latent in ganglionic neurons along the entire neuraxis. VZV reactivation results in zoster (shingles) which is frequently complicated by chronic pain (postherpetic neuralgia). VZV reactivation also causes meningoencephalitis, myelitis, ocular disorders, and vasculopathy, all of which can occur in the absence of rash. This review focuses on the association of VZV and stroke, and on the widening spectrum of disorders produced by VZV vasculopathy in immunocompetent and immunocompromised individuals, including recipients of varicella vaccine. Aside from ischemic stroke, VZV infection of cerebral arteries may lead to development of intracerebral aneurysms, with or without hemorrhage. Moreover, recent clinical-virological case reports and retrospective pathological-virological analyses of temporal arteries positive or negative for giant cell arteritis (GCA) indicate that extracranial VZV vasculopathy triggers the immunopathology of GCA. While many patients with GCA improve after corticosteroid treatment, prolonged corticosteroid use may potentiate VZV infection, leading to fatal vasculopathy in the brain and other organs. PMID:26750127

  15. Perspectives on optimal control of varicella and herpes zoster by mass routine varicella vaccination.

    PubMed

    Betta, Monica; Laurino, Marco; Pugliese, Andrea; Guzzetta, Giorgio; Landi, Alberto; Manfredi, Piero

    2016-03-16

    Herpes zoster arises from reactivation of the varicella-zoster virus (VZV), causing varicella in children. As reactivation occurs when cell-mediated immunity (CMI) declines, and there is evidence that re-exposure to VZV boosts CMI, mass varicella immunization might increase the zoster burden, at least for some decades. Fear of this natural zoster boom is the main reason for the paralysis of varicella immunization in Europe. We apply optimal control to a realistically parametrized age-structured model for VZV transmission and reactivation to investigate whether feasible varicella immunization paths that are optimal in controlling both varicella and zoster exist. We analyse the optimality system numerically focusing on the role of the cost functional, of the relative zoster-varicella cost and of the planning horizon length. We show that optimal programmes will mostly be unfeasible for public health owing to their complex temporal profiles. This complexity is the consequence of the intrinsically antagonistic nature of varicella immunization programmes when aiming to control both varicella and zoster. However, we show that gradually increasing-hence feasible-vaccination schedules can perform better than routine programmes with constant vaccine uptake. Finally, we show the optimal profiles of feasible programmes targeting mitigation of the post-immunization natural zoster boom with priority. PMID:26984627

  16. Herpes zoster ophthalmicus and varicella zoster virus vasculopathy.

    PubMed

    Bandeira, Francisco; Roizenblatt, Marina; Levi, Guido Carlos; Freitas, Denise de; Belfort, Rubens

    2016-04-01

    Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals. PMID:27224081

  17. 21 CFR 866.3900 - Varicella-zoster virus serological reagents.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Varicella-zoster virus serological reagents. 866... Varicella-zoster virus serological reagents. (a) Identification. Varicella-zoster virus serological reagents... viruses and provides epidemiological information on these diseases. Varicella (chicken pox) is a...

  18. 21 CFR 866.3900 - Varicella-zoster virus serological reagents.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Varicella-zoster virus serological reagents. 866... Varicella-zoster virus serological reagents. (a) Identification. Varicella-zoster virus serological reagents... viruses and provides epidemiological information on these diseases. Varicella (chicken pox) is a...

  19. 21 CFR 866.3900 - Varicella-zoster virus serological reagents.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Varicella-zoster virus serological reagents. 866... Varicella-zoster virus serological reagents. (a) Identification. Varicella-zoster virus serological reagents... viruses and provides epidemiological information on these diseases. Varicella (chicken pox) is a...

  20. 21 CFR 866.3900 - Varicella-zoster virus serological reagents.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Varicella-zoster virus serological reagents. 866... Varicella-zoster virus serological reagents. (a) Identification. Varicella-zoster virus serological reagents... viruses and provides epidemiological information on these diseases. Varicella (chicken pox) is a...

  1. 21 CFR 866.3900 - Varicella-zoster virus serological reagents.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Varicella-zoster virus serological reagents. 866... Varicella-zoster virus serological reagents. (a) Identification. Varicella-zoster virus serological reagents... viruses and provides epidemiological information on these diseases. Varicella (chicken pox) is a...

  2. Varicella zoster virus transmission in youth during incarceration.

    PubMed

    Moreau, Danusia; Besney, Jonathan; Jacobs, Angela; Woods, Dan; Joffe, Mark; Ahmed, Rabia

    2016-06-13

    Purpose - Facility-based Varicella zoster virus (VZV) transmission is reported in a Canadian youth offender correctional centre (YOCC). Transmission occurred from an immunocompetent youth offender (YO) with localized Herpes zoster to another immunocompetent single dose vaccinated YO, resulting in Varicella zoster (VZ) breakthrough disease. The purpose of this paper is to identify infection prevention and control (IPAC) measures utilized in this setting. Design/methodology/approach - A retrospective chart and immunization record review was conducted for two VZV cases and 27 exposed YO contacts in order to obtain demographic, clinical and immunization data. Descriptive data analysis was performed. Findings - All VZV cases and exposed contacts were male with an average age of 14.2 and 15.6 years for cases and contacts, respectively. Both cases shared the same living unit in the YOCC. There were 28 identified YO contacts, of whom 70 percent were single dose vaccinated with univalent vaccine, followed by 22 percent with a previous history of Varicella disease. All cases and contacts were born in Canada. No foreign-born populations were involved with this event. Infection control measures included additional precaution management, enhanced surveillance and environmental cleaning. As such, no hospitalizations or post-exposure immunizations were required. Originality/value - This report highlights the role that VZ breakthrough disease could play in fueling an outbreak in a high-risk environment without rapid recognition and implementation of preventative measures. It also underscores the importance of IPAC presence and public health immunization programs within correctional centers to avoid infectious disease threats. PMID:27219908

  3. [Vaccines against varicella-zoster virus (VZV)].

    PubMed

    Salleras, Luis; Salleras, Montserrat; Soldevila, Nuria; Prat, Andreu; Garrido, Patricio; Domínguez, Ángela

    2015-01-01

    In Western countries, two attenuated varicella vaccines derived from the OKA strain are licensed: Varilrix® GlaxoSmithKline (OKA/RIT strain) and Varivax® Merck Sharp and Dohme (OKA/Merck strain). Currently, in Spain, varicella vaccination is only included in the Ministry of Health, Social Services and Equality official vaccination calendar for administration in adolescents who have not had the disease. Given the good results obtained in Navarra and Madrid with universal administration of the vaccine in children, it would be desirable to include the vaccine in the routine immunization schedule, with the administration of two doses at 15-18 months of age in the future. The protective efficacy of the attenuated herpes zoster vaccine was evaluated in the Shingles Prevention Study, which showed that in the short term (0-4 years) the vaccine reduced the incidence of herpes zoster by 53%, post-herpetic neuralgia by 66%, and the disease burden in immunocompetent persons aged ≥60 years by 61%. Another study demonstrated protective efficacy in persons aged 50-59 years. Over time, the protective efficacy decreases, but remains at acceptable levels, especially for post-herpetic neuralgia and the disease burden. Recently, the results of a controlled clinical trial (phase III) conducted in 18 countries to assess the protective efficacy of the inactivated subunit vaccine (glycoprotein E) adjuvanted with the adjuvant AS01B were published. The study inferred that the vaccine significantly reduced the incidence of herpes zoster in the short term (3.2 years) in people aged ≥50 years. Vaccine protection did not decrease with age at vaccination, ranging between 96.8% and 97.9% in all age groups. PMID:26096575

  4. Varicella Zoster Virus in Saliva of Patients With Herpes Zoster

    NASA Technical Reports Server (NTRS)

    Mehta, Satish K.; Tyring, Stephen K.; Gilden, Donald H.; Cohrs, Randall J.; Leal, Melanie J.; Castro, Victoria A.; Feiveson, Alan H.; Ott, C. Mark; Pierson, Duane L.

    2007-01-01

    Background. VZV DNA is present in saliva of healthy astronauts and patients with Ramsay Hunt syndrome (geniculate zoster). We hypothesized that a prospective analysis of patients with zoster would detect VZV in saliva independent of zoster location. Methods. We treated 54 patients with valacyclovir. On the first treatment day, 7- and 14-days later, pain was scored and saliva examined for VZV DNA. Saliva from six subjects with chronic pain and 14 healthy subjects was similarly studied. Results. Follow-up data was available for 50/54 patients. Pain decreased in 43/50 (86 percent), disappeared in 37 (74 percent), recurred after disappearing in three (6 percent) and increased in four (8 percent). VZV DNA was found in every patient the day treatment was started, decreased in 47/50 (94 percent), transiently increased in three (6 percent) before decreasing, increased in two (4 percent) and disappeared in 41 (82 percent). There was a positive correlation between the presence of VZV DNA and pain, as well as between the VZV DNA copy number and pain (P<0.0005). Saliva of two patients was cultured, and infectious VZV was isolated from one. VZV DNA was present in one patient before rash and in four patients after pain resolved, and not in any control subjects. Conclusion. VZV DNA is present in saliva of zoster patients.

  5. The management of varicella-zoster virus exposure and infection in pregnancy and the newborn period. Australasian Subgroup in Paediatric Infectious Diseases of the Australasian Society for Infectious Diseases.

    PubMed

    Heuchan, A M; Isaacs, D

    2001-03-19

    Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection. Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease. Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy. Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox. ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery. Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG. Breastfeeding of babies infected with or exposed to VZV is encouraged. A mother with chickenpox or zoster does not need to be isolated from her own baby. If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative. The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG. After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation. PMID:11297117

  6. Varicella Zoster Infection: A Rare Cause of Abdominal Pain Mimicking Acute Abdomen

    PubMed Central

    Olmez, Deniz; Boz, Alper; Erkan, Nazif

    2009-01-01

    Varicella zoster is an acute viral infection that results from reactivation of a latent varicella zoster virus. It usually occurs in adult population and immune compromised patients. It rarely occurs in healthy children. Here we present a 14 years old male with varicella zoster that had abdominal pain mimicking acute abdomen to alert others who are consulted for the differentiation of acute abdomen and others who may be consulted for pain management. Keywords Varicella zoster; Abdominal pain PMID:22461879

  7. The Variegate Neurological Manifestations of Varicella Zoster Virus Infection

    PubMed Central

    Nagel, Maria A.; Cohrs, Randall J.; Mahalingam, Ravi

    2014-01-01

    Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which the virus becomes latent in ganglionic neurons along the entire neuraxis. With advancing age or immunosuppression, cell-mediated immunity to VZV declines, and the virus reactivates to cause zoster (shingles), dermatomal distribution, pain, and rash. Zoster is often followed by chronic pain (postherpetic neuralgia), cranial nerve palsies, zoster paresis, vasculopathy, meningoencephalitis, and multiple ocular disorders. This review covers clinical, laboratory, and pathological features of neurological complications of VZV reactivation, including diagnostic testing to verify active VZV infection in the nervous system. Additional perspectives are provided by discussions of VZV latency, animal models to study varicella pathogenesis and immunity, and of the value of vaccination of elderly individuals to boost cell-mediated immunity to VZV and prevent VZV reactivation. PMID:23884722

  8. Full-Genome Sequence of a Novel Varicella-Zoster Virus Clade Isolated in Mexico

    PubMed Central

    Rodríguez-Castillo, Araceli; Ortiz-Alcántara, Joanna María; Gonzalez-Durán, Elizabeth; Segura-Candelas, José Miguel; Pérez-Agüeros, Sandra Ivette; Escobar-Escamilla, Noé; Méndez-Tenorio, Alfonso; Diaz-Quiñonez, José Alberto

    2015-01-01

    Varicella-zoster virus (VZV) is a member of the Herpesviridae family, which causes varicella (chicken pox) and herpes zoster (shingles) in humans. Here, we report the complete genome sequence of varicella-zoster virus, isolated from a vesicular fluid sample, revealing the circulation of VZV clade VIII in Mexico. PMID:26159533

  9. Full-Genome Sequence of a Novel Varicella-Zoster Virus Clade Isolated in Mexico.

    PubMed

    Garcés-Ayala, Fabiola; Rodríguez-Castillo, Araceli; Ortiz-Alcántara, Joanna María; Gonzalez-Durán, Elizabeth; Segura-Candelas, José Miguel; Pérez-Agüeros, Sandra Ivette; Escobar-Escamilla, Noé; Méndez-Tenorio, Alfonso; Diaz-Quiñonez, José Alberto; Ramirez-González, José Ernesto

    2015-01-01

    Varicella-zoster virus (VZV) is a member of the Herpesviridae family, which causes varicella (chicken pox) and herpes zoster (shingles) in humans. Here, we report the complete genome sequence of varicella-zoster virus, isolated from a vesicular fluid sample, revealing the circulation of VZV clade VIII in Mexico. PMID:26159533

  10. Varicella zoster virus vaccines: potential complications and possible improvements.

    PubMed

    Silver, Benjamin; Zhu, Hua

    2014-10-01

    Varicella zoster virus (VZV) is the causative agent of varicella (chicken pox) and herpes zoster (shingles). After primary infection, the virus remains latent in sensory ganglia, and reactivates upon weakening of the cellular immune system due to various conditions, erupting from sensory neurons and infecting the corresponding skin tissue. The current varicella vaccine (v-Oka) is highly attenuated in the skin, yet retains its neurovirulence and may reactivate and damage sensory neurons. The reactivation is sometimes associated with postherpetic neuralgia (PHN), a severe pain along the affected sensory nerves that can linger for years, even after the herpetic rash resolves. In addition to the older population that develops a secondary infection resulting in herpes zoster, childhood breakthrough herpes zoster affects a small population of vaccinated children. There is a great need for a neuro-attenuated vaccine that would prevent not only the varicella manifestation, but, more importantly, any establishment of latency, and therefore herpes zoster. The development of a genetically-defined live-attenuated VZV vaccine that prevents neuronal and latent infection, in addition to primary varicella, is imperative for eventual eradication of VZV, and, if fully understood, has vast implications for many related herpesviruses and other viruses with similar pathogenic mechanisms. PMID:25358998

  11. Post varicella zoster virus myelitis in immunocompetent patients.

    PubMed

    Ben-Amor, Sana; Lammouchi, Turkia; Benslamia, Lamia; Benammou, Soufiene

    2011-04-01

    We report 2 immunocompetent patients with myelitis. The first was a 55-year old man who developed myelitis after intercostal herpes zoster. The second was a 19-year-old boy who presented with myelopathy after varicella infection. Varicella-zoster virus (VZV) myelitis was diagnosed based on the close temporal relationship between rash and onset of clinical symptoms, and by the elevated rate of anti-VZV IgG in the CSF without oligoclonal bands in the first case, and presence of VZV DNA in the second. The course was favorable after a 3-day course of corticosteroids and 3 weeks of acyclovir. Varicella-zoster virus myelitis is uncommon; it affects essentially immunodepressed patients. We highlight the importance of considering the possibility of VZV myelitis, even in immunocompetent patients. The combination of corticoids and acyclovir must be instituted, quickly, to improve functional outcome. PMID:21427667

  12. Recombination of Globally Circulating Varicella-Zoster Virus

    PubMed Central

    Depledge, Daniel P.; Kundu, Samit; Atkinson, Claire; Brown, Julianne; Haque, Tanzina; Hussaini, Yusuf; MacMahon, Eithne; Molyneaux, Pamela; Papaevangelou, Vassiliki; Sengupta, Nitu; Koay, Evelyn S. C.; Tang, Julian W.; Underhill, Gillian S.; Grahn, Anna; Studahl, Marie; Breuer, Judith; Bergström, Tomas

    2015-01-01

    ABSTRACT Varicella-zoster virus (VZV) is a human herpesvirus, which during primary infection typically causes varicella (chicken pox) and establishes lifelong latency in sensory and autonomic ganglia. Later in life, the virus may reactivate to cause herpes zoster (HZ; also known as shingles). To prevent these diseases, a live-attenuated heterogeneous vaccine preparation, vOka, is used routinely in many countries worldwide. Recent studies of another alphaherpesvirus, infectious laryngotracheitis virus, demonstrate that live-attenuated vaccine strains can recombine in vivo, creating virulent progeny. These findings raised concerns about using attenuated herpesvirus vaccines under conditions that favor recombination. To investigate whether VZV may undergo recombination, which is a prerequisite for VZV vaccination to create such conditions, we here analyzed 115 complete VZV genomes. Our results demonstrate that recombination occurs frequently for VZV. It thus seems that VZV is fully capable of recombination if given the opportunity, which may have important implications for continued VZV vaccination. Although no interclade vaccine-wild-type recombinant strains were found, intraclade recombinants were frequently detected in clade 2, which harbors the vaccine strains, suggesting that the vaccine strains have already been involved in recombination events, either in vivo or in vitro during passages in cell culture. Finally, previous partial and complete genomic studies have described strains that do not cluster phylogenetically to any of the five established clades. The additional VZV strains sequenced here, in combination with those previously published, have enabled us to formally define a novel sixth VZV clade. IMPORTANCE Although genetic recombination has been demonstrated to frequently occur for other human alphaherpesviruses, herpes simplex viruses 1 and 2, only a few ancient and isolated recent recombination events have hitherto been demonstrated for VZV. In the

  13. [VARICELLA ZOSTER VIRUS AND DISEASES OF CENTRAL NERVOUS SYSTEM VESSELS].

    PubMed

    Kazanova, A S; Lavrov, V F; Zverev, V V

    2015-01-01

    Systemized data on epidemiology, pathogenesis, clinical manifestation, diagnostics and therapy of VZV-vasculopathy--a disease, occurring due to damage of arteries of the central nervous system by Varicella Zoster virus, are presented in the review. A special attention in the paper is given to the effect of vaccine prophylaxis of chicken pox and herpes zoster on the frequency of development and course of VZV-vasculopathy. PMID:26259280

  14. Kawasaki disease onset during concomitant infections with varicella zoster and Epstein-Barr virus.

    PubMed Central

    Turkay, Sadi; Odemis, Ender; Karadag, Ahmet

    2006-01-01

    Kawasaki disease is an acute systemic vasculitis that predominantly affects preschool-aged children. It has a predilection to coronary arteries, and its precise etiology is still unknown. Many infectious agents, including viruses and bacteria, have been suggested as potential causes of the disease. Here, we report a patient who met the diagnostic criteria of Kawasaki disease during concomitant Epstein-Barr virus and varicella-zoster virus infections, and we discuss the possible roles of these viruses in etiology. PMID:16916136

  15. Lineages of varicella-zoster virus.

    PubMed

    McGeoch, Duncan J

    2009-04-01

    Relationships among varicella-zoster virus (VZV; Human herpesvirus 3) genome sequences were examined to evaluate descent of strains, structures of lineages and incidence of recombination events. Eighteen complete, published genome sequences were aligned and 494 single nucleotide polymorphisms (SNPs) extracted, each as two alleles. At 281 SNPs, a single sequence differed from all the others. Distributions of the remaining 213 SNPs indicated that the sequences fell into five groups, which coincided with previously recognized phylogenetic groupings, termed E1, E2, J, M1 and M2. The 213-SNP set was divisible into 104 SNPs that were specific to a single group, and 109 cross-group SNPs that defined relationships among groups. This last set was evaluated by criteria of continuities in relationships between groups and breaks in such patterns, to identify crossover points and ascribe them to lineages. For the 99 cross-group SNPs in the genome's long unique region, it was seen that the E2 and M2 groups were almost completely distinct in their SNP alleles, and the E1 group was derived from a recombinant of E2 and M2. A valid phylogenetic tree could thus be constructed for the four E2 and two M2 strains. There was no substantive evidence for recombination within the E2 group or the E1 group (ten strains). The J and M1 groups each contained only one strain, and both were interpreted as having substantial distinct histories plus possible recombinant elements from the E2 and M2 lineages. The view of VZV recombination and phylogeny reached represents a major clarification of deep relationships among VZV lineages. PMID:19264671

  16. Advances in the treatment of varicella-zoster virus infections.

    PubMed

    Andrei, G; Snoeck, R

    2013-01-01

    Varicella-zoster virus (VZV) causes two distinct diseases, varicella (chickenpox) and shingles (herpes zoster). Chickenpox occurs subsequent to primary infection, while herpes zoster (usually associated with aging and immunosuppression) appears as a consequence of reactivation of latent virus. The major complication of shingles is postherpetic neuralgia. Vaccination strategies to prevent varicella or shingles and the current status of antivirals against VZV will be discussed in this chapter. Varivax®, a live-attenuated vaccine, is available for pediatric varicella. Zostavax® is used to boost VZV-specific cell-mediated immunity in adults older than 50 years, which results in a decrease in the burden of herpes zoster and pain related to postherpetic neuralgia. Regardless of the availability of a vaccine, new antiviral agents are necessary for treatment of VZV infections. Current drugs approved for therapy of VZV infections include nucleoside analogues that target the viral DNA polymerase and depend on the viral thymidine kinase for their activation. Novel anti-VZV drugs have recently been evaluated in clinical trials, including the bicyclic nucleoside analogue FV-100, the helicase-primase inhibitor ASP2151, and valomaciclovir (prodrug of the acyclic guanosine derivative H2G). Different candidate VZV drugs have been described in recent years. New anti-VZV drugs should be as safe as and more effective than current gold standards for the treatment of VZV, that is, acyclovir and its prodrug valacyclovir. PMID:23886000

  17. Varicella zoster virus brachioplexitis associated with granulomatous vasculopathy.

    PubMed

    Fleming, J; Fogo, A; Haider, S; Diaz-Cano, S; Hay, R; Bashir, S

    2013-06-01

    Varicella zoster virus (VZV) causes the common childhood disease chickenpox (varicella), or upon reactivation, the dermatomal vesiculopustular eruption seen in shingles (herpes zoster). The clinical course of herpes zoster in immunocompromised patients is often recurrent, protracted and multidermatomal, and it can result in myelitis, meningoencephalitis, and cerebral or small-vessel vasculopathic or vasculitic changes. Commonly, the vesicular rash settles with aciclovir therapy and does not involve motor neuropathy. We report a 63-year-old man with a prolonged, multidermatomal, nonvesicular rash, and limb paresis secondary to brachioplexitis. PCR for VZV was positive, and the histological results were consistent with granulomatous vasculopathy. Prolonged treatment with valaciclovir was required to resolve the eruption and help improve the patient's motor function. We discuss the problems faced in clinical decision-making about immunosuppressive treatment of granulomatous vasculopathy and motor neuropathy, when any increase in immunosuppressive therapy may increase the likelihood of central nervous system complications. PMID:23621091

  18. Universal varicella vaccination: efficacy trends and effect on herpes zoster.

    PubMed

    Goldman, Gary S

    2005-01-01

    In 1995, the Varicella Active Surveillance Project (VASP) was established in Antelope Valley (California), a geographically distinct high-desert community of 300,000 residents, as one of three sites in the nation in a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to collect baseline demographic and clinical data and to monitor trends in varicella (chickenpox) following introduction of varicella vaccine. Herpes zoster (shingles) was added to the active surveillance January 1, 2000. The universal varicella program has proven effective in terms of reducing the number of reported verified varicella cases by 85%, from 2,934 in 1995 to 412 in 2002. Prior to this dramatic reduction, immunologic boosting due to exogenous exposures to wild-type varicella-zoster virus (VZV) in the community (1) caused mean serum anti-VZV levels among vaccines to increase with time after vaccination and (2) served as a mechanism that helped suppress the reactivation of herpes zoster (HZ), especially among individuals with a previous history of wild-type varicella. That immunologic boosting might play a significant role in both varicella and the closely related HZ epidemiology is evidenced by (1) a decline in vaccine efficacy by over 20%, from 95.7% (95% C.I., 82.7% to 98.9%) in 1999 to 73.9% (95% C.I., 57.9% to 83.8%) in 2001 and (2) an unexpectedly high cumulative (2000 to 2003) true incidence rate of 223 (95% C.I. 180-273) per 100,000 person-years (p-y) among children <10 years old with a previous history of varicella. Because capture-recapture methods demonstrate a likely lower bound of 50% underreporting, the actual rate is likely double or 446 per 100,000 p-y, approaching the HZ rate reported among older adults. Other recent studies based on VASP data have mitigated against discovery of the above trends that challenge several initial assumptions inherent to the universal varicella program, namely, (1) a single dose confers long-term immunity and (2

  19. Fatal disseminated varicella zoster infection following zoster vaccination in an immunocompromised patient.

    PubMed

    Costa, E; Buxton, J; Brown, J; Templeton, K E; Breuer, J; Johannessen, I

    2016-01-01

    A 79-year-old man with chronic lymphocytic leukaemia presented with fever and a widespread vesicular rash on 19 November 2014. The patient had not been under immunosuppressive regime for 6 months. He had received a shingles vaccine on 14th October and developed flu-like symptoms after 2 weeks. Intravenous antimicrobial therapy including aciclovir was started. He remained stable with no evidence of systemic involvement. On day 5, he developed respiratory and renal failure that required transfer to intensive care unit. Vesicle fluid, bronchoalveolar lavage and plasma were positive for varicella zoster virus by PCR. Slight clinical improvement allowed extubation on day 16. He subsequently deteriorated and died on day 25. Multiorgan failure was considered the immediate cause of death whereas disseminated varicella zoster infection was stated in the medical certificate as the other condition leading to this outcome. Varicella zoster Oka vaccine strain was detected in vesicle fluid, using PCR. PMID:27147629

  20. Varicella Zoster Virus and Internal Root Resorption: A Case Report.

    PubMed

    Talebzadeh, Bita; Rahimi, Saeed; Abdollahi, Amir Ardalan; Nouroloyuni, Ahmad; Asghari, Vahide

    2015-08-01

    Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus. One of the less well-recognized maxillofacial complications is tooth root resorption. To our knowledge, this is the first case report about internal resorption associated with varicella zoster virus involving different dental quadrants. A 38-year-old woman presented with internal resorption of maxillary canine and first premolar tooth roots on the right quadrant and generalized internal resorption of second molars of both mandibular quadrants. The patient's medical history showed mild oral lichen planus and infection with varicella zoster virus (chickenpox) with severe clinical manifestations 5 years previously. The patient developed diabetes mellitus type I and hypothyroidism a short time after varicella zoster virus infection, and by the time of infection with this virus, oral lichen planus had progressed from the reticular pattern to the generalized severe erosive form. Viral etiology could also be considered in these diseases. The root canals of the affected teeth were debrided, irrigated, and dried, and calcium hydroxide paste was placed in the root canals for a week during the first treatment session. The root canals were obturated during the second session. Six-month follow-up showed improvement of oral lichen planus and resolution of widening of periodontal ligament of the affected teeth, with follow-up radiographs revealing no periapical problems. It appears some cases of internal root resorption classified as idiopathic might have viral etiology. Therefore, it is recommended that patients be questioned about a history of chickenpox and herpes zoster. PMID:25814244

  1. Salivary Varicella Zoster Virus in Astronauts and in Patients of Herpes Zoster

    NASA Technical Reports Server (NTRS)

    Mehta, Satish; Pierson, Duane L.

    2010-01-01

    Spaceflight is a uniquely stressful environment with astronauts experiencing a variety of stressors including: isolation and confinement, psychosocial, noise, sleep deprivation, anxiety, variable gravitational forces, and increased radiation. These stressors are manifested through the HPA and SAM axes resulting in increased stress hormones. Diminished T-lymphocyte functions lead to reactivation of latent herpes viruses in astronauts during spaceflight. Herpes simplex virus reactivated with symptoms during spaceflight whereas Epstein-Barr virus (EBV), cytomegalovirus (CMV), and varicella zoster virus (VZV) reactivate and are shed without symptoms. EBV and VZV are shed in saliva and CMV in the urine. The levels of EBV shed in astronauts increased 10-fold during the flight; CMV and VZV are not typically shed in low stressed individuals, but both were shed in astronauts during spaceflight. All herpesviruses were detected by polymerase chain reaction (PCR) assay. Culturing revealed that VZV shed in saliva was infectious virus. The PCR technology was extended to test saliva of 54 shingles patients. All shingles patients shed VZV in their saliva, and the levels followed the course of the disease. Viremia was also found to be common during shingles. The technology may be used before zoster lesions appear allowing for prevention of disease. The technology may be used for rapid detection of VZV in doctors? offices. These studies demonstrated the value of applying technologies designed for astronauts to people on Earth.

  2. Rapid Detection of the Varicella Zoster Virus

    NASA Technical Reports Server (NTRS)

    Lewis, Michelle P.; Harding, Robert

    2011-01-01

    1.Technology Description-Researchers discovered that when the Varicella Zoster Virus (VZV) reactivates from latency in the body, the virus is consistently present in saliva before the appearance of skin lesions. A small saliva sample is mixed with a specialized reagent in a test kit. If the virus is present in the saliva sample, the mixture turns a red color. The sensitivity and specificity emanates from an antibody-antigen reaction. This technology is a rapid, non-invasive, point of-of-care testing kit for detecting the virus from a saliva sample. The device is easy to use and can be used in clinics and in remote locations to quickly detect VZV and begin treatment with antiviral drugs. 2.Market Opportunity- RST Bioscience will be the first and only company to market a rapid, same day test kit for the detection of VZV in saliva. The RST detection test kit will have several advantages over existing, competitive technology. The test kit is self contained and laboratory equipment is not required for analysis of the sample. Only a single saliva sample is required to be taken instead of blood or cerebral spinal fluid. The test kit is portable, sterile and disposable after use. RST detection test kits require no electrical power or expensive storage equipment and can be used in remote locations. 3.Market Analysis- According to the CDC, it is estimated that 1 million cases of shingles occur each year in the U.S. with more than half over the age of sixty. There is a high demand for rapid diagnostics by the public. The point-of-care testing (POCT) market is growing faster than other segments of in vitro diagnostics. According to a July 2007 InteLab Corporation industry report the overall market for POCT was forecast to increase from $10.3 billion in 2005 to $18.7 billion by 2011. The market value of this test kit has not been determined. 4.Competition- The VZV vaccine prevents 50% of cases and reduces neuralgia by 66%. The most popular test detects VZV-specific IgM antibody

  3. Rapid Detection of the Varicella Zoster Virus in Saliva

    NASA Technical Reports Server (NTRS)

    Pierson, Duane L.; Mehta, Satish K.; Cohrs, Randall J.; Gilden, Don H.; Harding, Robert E.

    2011-01-01

    Varicella zoster virus (VZV) causes chicken pox on first exposure (usually in children), and reactivates from latency causing shingles (usually in adults). Shingles can be extremely painful, causing nerve damage, organ damage, and blindness in some cases. The virus can be life-threatening in immune-compromised individuals. The virus is very difficult to culture for diagnosis, requiring a week or longer. This invention is a rapid test for VZV from a saliva sample and can be performed in a doctor s office. The kit is small, compact, and lightweight. Detec tion is sensitive, specific, and noninvasive (no needles); only a saliva sample is required. The test provides results in minutes. The entire test is performed in a closed system, with no exposure to infectious materials. The components are made mostly of inexpensive plastic injection molded parts, many of which can be purchased off the shelf and merely assembled. All biological waste is contained for fast, efficient disposal. This innovation was made possible because of discovery of a NASA scientists flight experiment showing the presence of VZV in saliva during high stress periods and disease. This finding enables clinicians to quickly screen patients for VZV and treat the ones that show positive results with antiviral medicines. This promotes a rapid recovery, easing of pain and symptoms, and reduces chances of complications from zoster. Screening of high-risk patients could be incorporated as part of a regular physical exam. These patients include the elderly, pregnant women, and immune-compromised individuals. In these patients, VZV can be a life-threatening disease. In both high- and low-risk patients, early detection and treatment with antiviral drugs can dramatically decrease or even eliminate the clinical manifestation of disease.

  4. Immunological evasion of immediate-early varicella zoster virus proteins.

    PubMed

    Meysman, Pieter; Fedorov, Dmitry; Van Tendeloo, Viggo; Ogunjimi, Benson; Laukens, Kris

    2016-07-01

    The varicella zoster virus (VZV) causes the childhood disease commonly known as chickenpox and can later in life reactivate as herpes zoster. The adaptive immune system is known to play an important role in suppressing VZV reactivation. A central aspect of this system is the presentation of VZV-derived peptides by the major histocompatibility complex (MHC) proteins. Here, we investigate if key VZV proteins have evolved their amino acid sequence to avoid presentation by MHC based on predictive models of MHC-peptide affinity. This study shows that the immediate-early proteins of all characterized VZV strains are profoundly depleted for high-affinity MHC-I-restricted epitopes. The same depletion can be found in its closest animal analog, the simian varicella virus. Further orthology analysis towards other herpes viruses suggests that the protein amino acid frequency is one of the primary drivers of targeted epitope depletion. PMID:27020058

  5. Central nervous system infections caused by varicella-zoster virus.

    PubMed

    Chamizo, Francisco J; Gilarranz, Raúl; Hernández, Melisa; Ramos, Diana; Pena, María José

    2016-08-01

    We carried out a clinical and epidemiological study of adult patients with varicella-zoster virus central nervous system infection diagnosed by PCR in cerebrospinal fluid. Twenty-six patients were included. Twelve (46.2 %) patients were diagnosed with meningitis and fourteen (53.8 %) with meningoencephalitis. Twelve (46.2 %) had cranial nerves involvement (mainly the facial (VII) and vestibulocochlear (VIII) nerves), six (23.1 %) had cerebellar involvement, fourteen (53.8 %) had rash, and four (15.4 %) developed Ramsay Hunt syndrome. Three (11.5 %) patients had sequelae. Length of stay was significantly lower in patients diagnosed with meningitis and treatment with acyclovir was more frequent in patients diagnosed with meningoencephalitis. We believe routine detection of varicella-zoster virus, regardless of the presence of rash, is important because the patient may benefit from a different clinical management. PMID:26769041

  6. [The genotyping and molecular evolution of varicella-zoster virus].

    PubMed

    Jiang, Long-Feng; Gan, Lin; Chen, Jing-Xian; Wang, Ming-Li

    2012-09-01

    Varicella-zoster virus (VZV, Human herpesvirus 3) is a member of the family Herpesviridae, and is classified as alpha-subfamily along with HSV-1 and HSV-2. VZV is the causative agent of chicken pox (varicella) mostly in children, after which it establishes latency in the sensory ganglia with the potential to reactivate at a later time to cause shingles (zoster). Increasing molecular epidemiological studies in recent years have been performed to monitor the mutations in VZV genome, discriminate vaccine virus from wild type virus, study the phylogeny of VZV strains throughout the world, and understand the evolution of the different clades of VZV. The progress has great impact on the fields of epidemiology, virology and bioinformatics. In this review, the currently available data concerning the geographic distribution and molecular evolution of VZV clades are discussed. PMID:23233938

  7. Necrotising fasciitis: a sequelae of varicella zoster infection.

    PubMed

    Shirley, Rebecca; Mackey, Simon; Meagher, Peter

    2011-01-01

    Necrotising fasciitis (NF) can complicate varicella zoster virus in children. This is rare and has not previously been reported in the plastic surgery literature. We report a case of a female toddler who developed necrotising fasciitis secondary to chicken pox. Her presentation and progress are reported, the diagnosis of necrotising fasciitis in children and the small number of case series and case control studies are discussed. PMID:20570582

  8. [Varicella-zoster virus and pregnancy].

    PubMed

    Charlier, Caroline; Le Mercier, Delphine; Salomon, Laurent J; Ville, Yves; Kermorvant-Duchemin, Elsa; Frange, Pierre; Postaire, Martine; Lortholary, Olivier; Lecuit, Marc; Leruez-Ville, Marianne

    2014-06-01

    The incidence of varicella is low in pregnant women, and estimated around 1/1000 pregnancies. Vaccination is the cornerstone of prevention, but is contraindicated during pregnancy. Varicella is more severe in pregnant women. The risk of viral pneumonia is not increased, but VZV-associated pneumonia is usually more severe in pregnant women. Infection between 0-20 WG is associated with a 2 % risk of congenital varicella syndrome. Infection between D-5 and D+2 of delivery is associated with high risk of severe neonatal infection. Non-immune pregnant women with significant exposure to VZV require post-exposure prophylaxis with specific anti-VZV immunoglobulins that should be administered ideally within 4 days post-exposure and maximum within 10 days of exposure. Anti-VZV immunoglobulins are available in France in the context of an approved expanded access to an investigational new drug. Pregnant women with varicella should receive within 24 hours antiviral treatment based either on valaciclovir or, in case of severe infection, intravenous aciclovir. Both drugs were shown safe during pregnancy, even during the first trimester. Neonates born from mothers who developed varicella between D-5 and D+2 of delivery should also receive as soon as possible specific anti-VZV immunoglobulins. PMID:24863663

  9. Clinical and molecular aspects of varicella zoster virus infection

    PubMed Central

    Gilden, Don; Nagel, Maria A.; Mahalingam, Ravi; Mueller, Niklaus H.; Brazeau, Elizabeth A.; Pugazhenthi, Subbiah; Cohrs, Randall J.

    2009-01-01

    Summary A declining cell-mediated immunity to varicella zoster virus (VZV) with advancing age or immunosuppression results in virus reactivation from latently infected human ganglia anywhere along the neuraxis. Virus reactivation produces zoster, often followed by chronic pain (postherpetic neuralgia or PHN) as well as vasculopathy, myelopathy, retinal necrosis and cerebellitis. VZV reactivation also produces pain without rash (zoster sine herpete). Vaccination after age 60 reduces the incidence of shingles by 51%, PHN by 66% and the burden of illness by 61%. However, even if every healthy adult over age 60 years is vaccinated, there would still be about 500,000 zoster cases annually in the United States alone, about 200,000 of whom will experience PHN. Analyses of viral nucleic acid and gene expression in latently infected human ganglia and in an animal model of varicella latency in primates are serving to determine the mechanism(s) of VZV reactivation with the aim of preventing reactivation and the clinical sequelae. PMID:19946620

  10. The challenging patient with varicella-zoster virus disease

    PubMed Central

    Nagel, Maria A.

    2013-01-01

    Summary Varicella-zoster virus (VZV) reactivation from latently infected ganglia causes multiple neurologic diseases. The most common is herpes zoster, which is frequently complicated by postherpetic neuralgia, meningoencephalitis, and vasculopathy, including VZV temporal arteritis, myelopathy, and retinal necrosis. All of these disorders can develop without rash. Importantly, VZV vasculopathy is emerging as a significant cause of TIAs and stroke. In particular, a subset of patients who present with symptoms and signs of giant cell arteritis (GCA), but whose temporal artery biopsies are GCA-negative, have multifocal VZV vasculopathy with temporal artery infection. Herein we focus on the specific diagnostic and therapeutic challenges that clinical neurologists encounter in diseases caused by VZV, discuss guidelines for zoster vaccine, and highlight molecular features of VZV latency with a focus on preventing the serious neurologic and ocular complications of VZV reactivation. PMID:23914320

  11. Brief communication: A 61-year-old woman with vesicular eruption after varicella zoster vaccination

    PubMed Central

    Spriet, Sarah; Banks, Taylor A.

    2016-01-01

    Background: Vesicular rashes are associated with a variety of infectious and noninfectious causes. Objective: To discuss the differential diagnoses of vesicular rashes. Methods: We present the clinical case of an adult woman who was immunocompetent and who developed several clear fluid-filled vesicles on her upper extremity within days of receiving the varicella zoster vaccine. Over the next several days, the skin eruption generalized, and she developed new lesions in various stages of healing. Results: After a detailed history and further studies were obtained, a final diagnosis was made. Conclusion: In patients who have recently been vaccinated, a high index of suspicion for an adverse vaccine reaction should be maintained. PMID:27349562

  12. Bilateral Retrobulbar Optic Neuritis Caused by Varicella Zoster Virus in a Patient with AIDS

    PubMed Central

    Duda, Jose F.; Castro, Jose G.

    2015-01-01

    Aims To report on a case of bilateral retrobulbar optic neuritis in a patient with acquired immune deficiency syndrome (AIDS) caused by varicella-zoster virus (VZV); and to review the literature focusing on: cases reported, epidemiology, pathophysiology, diagnosis and treatment. Presentation of Case A 38-year-old woman with AIDS presented with a 10-day history of progressive bilateral visual loss and ocular pain. She had bilateral dilated pupils with no light perception; the fundoscopic examination was normal. Facial herpes zoster lesions appeared on the second day of hospitalization Magnetic resonance imaging (MRI) findings were compatible with a bilateral optic neuritis; the cerebrospinal fluid (CSF) showed pleocytosis, increased proteins and a positive VZV-DNA PCR. She was treated with intravenous acyclovir and corticosteroids and was able, when discharged 2 weeks after admission, to carry out activities of daily living. Discussion VZV retrobulbar optic neuritis has previously been reported in 12 patients with AIDS, more than half of the cases had concomitant herpes zoster and an associated retinopathy. A positive VZV-DNA in the CSF is indicative of VZV infection, initial use of intravenous acyclovir is recommended, and the concomitant use of corticosteroids would be a prudent choice; the duration of antiviral therapy remains undefined. Conclusion VZV retrobulbar optic neuritis in AIDS patients can occur with or without herpes zoster. It is a sight-threatening infectious and inflammatory process requiring the advice of specialists in infectious diseases, ophthalmology, neurology and viral microbiology. PMID:26740936

  13. [Varicella Zoster infections in adults: beyond shingles?].

    PubMed

    Buvelot, Hélène; Lebowitz, Dan; Huttner, Benedikt; Schibler, Manuel; Kaiser, Laurent; Abbas, Mohamed

    2016-04-13

    Chickenpox is a generally benign condition during childhood, but it can cause severe complications when affecting teenage or adult patients. Immunodeficiency and pregnancy are risk factors for disseminated disease with pulmonary, neurological and/or hepatic involvement. Reinfection may be more frequent than previously thought, and management is identical to that of primary infection. The most common manifestation of viral reactivation is shingles, but it can also cause meningitis and vasculopathy, as well as disseminated herpes zoster in the immunocompromised patient. In this article, we will review the clinical manifestations and management of VZV infection in adults. PMID:27263149

  14. Frequency of varicella zoster virus DNA in human adrenal glands.

    PubMed

    Badani, Hussain; White, Teresa; Schulick, Nicole; Raeburn, Christopher D; Topkaya, Ibrahim; Gilden, Don; Nagel, Maria A

    2016-06-01

    Varicella zoster virus (VZV) becomes latent in ganglionic neurons derived from neural crest cells. Because the adrenal gland also contains medullary chromaffin cells of neural crest origin, we examined human adrenal glands and medullary chromaffin cell tumors (pheochromocytomas) for VZV and herpes simplex virus type 1 (HSV-1). We found VZV, but not HSV-1, DNA in 4/63 (6 %) normal adrenal glands. No VZV transcripts or antigens were detected in the 4 VZV DNA-positive samples. No VZV or HSV-1 DNA was found in 21 pheochromocytomas. PMID:26843382

  15. Varicella zoster immune status in children treated for acute leukemia.

    PubMed

    Patel, Soonie R; Bate, Jessica; Maple, Peter A C; Brown, Kevin; Breuer, Judith; Heath, Paul T

    2014-11-01

    Children treated for acute leukemia are at increased risk of severe infection with varicella zoster virus (VZV). We studied the VZV sero-status of children with acute leukemia prior to starting chemotherapy and after completion of chemotherapy. VZV sero-status was assessed using time resolved fluorescence immunoassay (TRFIA) before starting treatment and 6 months after completion of treatment. Prior to starting treatment for acute leukemia, a significant proportion of children (35%) are VZV seronegative. On completion of treatment most patients maintained protective VZV antibody levels; however, 35% had reduced/loss VZV antibody to a level considered non-protective and susceptible to VZV infection. PMID:24789692

  16. Neurological Disease Produced by Varicella Zoster Virus Reactivation Without Rash

    PubMed Central

    Gilden, Don; Cohrs, Randall J.; Mahalingam, Ravi; Nagel, Maria A.

    2010-01-01

    Reactivation of varicella zoster virus (VZV) from latently infected human ganglia usually produces herpes zoster (shingles), characterized by dermatomal distribution pain and rash. Zoster is often followed by chronic pain (postherpetic neuralgia or PHN) as well as meningitis or meningoencephalitis, cerebellitts, isolated cranial nerve palsies that produce ophthalmoplegia or the Ramsay Hunt syndrome, multiple cranial nerve palsies (polyneuritis cranialis), vasculopathy. myelopathy, and various inflammatory disorders of the eye. Importantly, VZV reactivation can produce chronic radicular pain without rash (zoster sine herpete), as well as all the neurological disorders listed above without rash. The protean neurological and ocular disorders produced by VZV in the absence of rash are a challenge to the practicing clinician. The presentation of these conditions vanes from acute to subacute to chronic. Virological confirmation requires the demonstration of amplifiable VZV DNA in cerebrospinal fluid (CSF) or in blood mononuclear cells, or the presence of anti-VZV IgG antibody in CSF or of anti-VZV IgM antibody in CSF or serum. PMID:20186614

  17. Varicella zoster meningitis complicating combined anti-tumor necrosis factor and corticosteroid therapy in Crohn's disease.

    PubMed

    Ma, Christopher; Walters, Brennan; Fedorak, Richard N

    2013-06-01

    Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy. PMID:23745038

  18. Varicella-Zoster Virus–Specific Antibody Responses in 50–59-Year-Old Recipients of Zoster Vaccine

    PubMed Central

    Levin, Myron J.; Schmader, Kenneth E.; Gnann, John W.; McNeil, Shelly A.; Vesikari, Timo; Betts, Robert F.; Keay, Susan; Stek, Jon E.; Bundick, Nickoya D.; Su, Shu-Chih; Zhao, Yanli; Li, Xiaoming; Chan, Ivan S. F.; Annunziato, Paula W.; Parrino, Janie

    2013-01-01

    Prevaccination and 6-week postvaccination samples from the immunogenicity substudy (n = 2269) of the zoster vaccine (ZV) efficacy trial (N = 22 439) in 50–59-year-old subjects were examined for varicella-zoster virus–specific antibody responses to vaccination. The varicella-zoster virus geometric mean titer (GMT) and geometric mean fold rise were higher in ZV recipients than in placebo recipients (GMT, 660.0 vs 293.1 glycoprotein enzyme-linked immunosorbent assay units/mL [P < .001], respectively; geometric mean fold rise, 2.31 vs 1.00 [P < .025]). In each group there was a strong inverse correlation between postvaccination GMT and risk of subsequent herpes zoster. Although these data provide strong evidence that relates ZV-induced antibody and the risk of herpes zoster, a protective threshold was not determined. Clinical Trials Registration. NCT00534248. PMID:23908486

  19. Microbiology laboratory and the management of mother-child varicella-zoster virus infection

    PubMed Central

    De Paschale, Massimo; Clerici, Pierangelo

    2016-01-01

    Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn

  20. Microbiology laboratory and the management of mother-child varicella-zoster virus infection.

    PubMed

    De Paschale, Massimo; Clerici, Pierangelo

    2016-08-12

    Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn

  1. Varicella-Zoster Virus Vasculopathy: A Case Report Demonstrating Vasculitis using Black-Blood MRI

    PubMed Central

    Shah, Jay; Poonawala, Husain; Keay, Susan K; Serulle, Yafell; Steven, Andrew; Gandhi, Dheeraj; Cole, John W

    2016-01-01

    Infections are rare but important causes of stroke. Among these, varicella zoster virus has been known to cause ischemic stroke. During an attack of herpes zoster ophthalmicus, it has been hypothesized that the virus replicates in the trigeminal ganglion and travels via the trigeminal nerve centrally to cause cerebral vasculopathy. Here we present a case of a 69 year-old Caucasian immunocompromised woman who suffered recurrent ischemic infarcts within the same vascular distribution following an episode of zoster ophthalmicus three months prior. An imaging technique termed black-blood magnetic resonance imaging was utilized to aid in the diagnosis of cerebral vasculitis. The case is used to provide a literature review of the pathogenesis, diagnosis, and treatment of cerebral varicella zoster vasculopathy. In situations where an isolated unilateral cerebral vasculopathy is identified, neurologists are urged to consider varicella zoster as a treatable etiologic agent, as untreated vasculopathy can lead to further strokes. PMID:27065314

  2. Varicella Zoster Aseptic Meningitis: Report of an Atypical Case and Literature Review

    PubMed Central

    Ibrahim, Walid; Elzouki, Abdel-Naser; Husain, Ahmed; Osman, Lubna

    2015-01-01

    Patient: Female, 15 Final Diagnosis: Varicella Zoster aseptic meningitis Symptoms: — Medication: — Clinical Procedure: Lumber punctur Specialty: Infectious Diseases Objective: Unusual clinical course Background: Neurologic complications can occur with varicella zoster virus (VZV) infection, usually after vesicular exanthem. A review of the literature revealed 3 cases of viral meningitis associated with 6th nerve palsy but without significantly increased intracranial pressure. Case Report: We report a case of a previously healthy 15-year-old girl with aseptic meningitis as a result of reactivated-VZV infection with symptoms of increased intracranial pressure and reversible 6th cranial nerve palsy but without exanthema. Diagnosis was made by detection of VZV-DNA in cerebrospinal fluid using polymerase chain reaction and documented high intracranial pressure. Full recovery was achieved after a course of acyclovir and acetazolamide. Conclusions: This case demonstrates that VZV may be considered in cases of aseptic meningitis in immunocompetent individuals, even without exanthema, and it may increase the intracranial pressure, leading to symptoms, and causing reversible neurological deficit. PMID:26342350

  3. Processing of virus-specific glycoproteins of varicella zoster virus

    SciTech Connect

    Namazue, J.; Campo-Vera, H.; Kitamura, K.; Okuno, T.; Yamanishi, K.

    1985-05-01

    Monoclonal antibodies to varicella zoster virus (VZV) glycoproteins were used to study the processing of three glycoproteins with molecular weights of 83K-94K (gp 2), 64K (gp 3), and 55K (gp 5). Immunoprecipitation experiments performed with VZV-infected cells, pulse labeled with (/sup 3/H)glucosamine in the presence of tunicamycin, suggest that O-linked oligosaccharide is present on the glycoprotein of gp 2. Use of the enzyme endo-beta-N-acetylglucosaminidase H revealed that the fully processed form of gp 3 had high-mannose type and that of gp 5 had only complex type of N-linked oligosaccharides. Experiments with monensin suggest that the precursor form (116K) of gp 3 is cleaved during the processing from Golgi apparatus to cell surface membrane. The extension of O-linked oligosaccharide chain and the complex type of N-linked oligosaccharide chains also occurs during this processing.

  4. Chronic cutaneous varicella zoster virus infection complicating dermatomyositis.

    PubMed

    Hoesly, Fridolin J; Sluzevich, Jason C

    2014-04-01

    Chronic cutaneous varicella zoster virus (VZV) infection has not been previously reported or characterized as a complication of dermatomyositis. Two patients with non-malignancy-associated dermatomyositis, treated with long-term prednisone and methotrexate, developed persistent, painless ulcers ultimately established to be secondary to chronic VZV. The absence of pain or a history suggestive of acute VZV, and the lack of characteristic histopathology, resulted in a lengthy delay in diagnosis. Polymerase chain reaction and tissue immunohistochemistry were positive for VZV, and treatment with valacyclovir resulted in complete clearance. Diagnostic testing for VZV should thus be considered in the evaluation of ulcerative lesions in patients with dermatomyositis. The increased incidence of acute VZV in combination with the nature and duration of immunosuppressive treatment in this patient population may be contributory. PMID:24480012

  5. Varicella Zoster Virus Infection in Granulomatous Arteritis of the Aorta.

    PubMed

    Gilden, Don; White, Teresa; Boyer, Philip J; Galetta, Kristin M; Hedley-Whyte, E Tessa; Frank, Meredith; Holmes, Dawn; Nagel, Maria A

    2016-06-15

    Granulomatous arteritis characterizes the pathology of giant cell arteritis, granulomatous aortitis, and intracerebral varicella zoster virus (VZV) vasculopathy. Because intracerebral VZV vasculopathy and giant cell arteritis are strongly associated with productive VZV infection in cerebral and temporal arteries, respectively, we evaluated human aortas for VZV antigen and VZV DNA. Using 3 different anti-VZV antibodies, we identified VZV antigen in 11 of 11 aortas with pathologically verified granulomatous arteritis, in 1 of 1 cases of nongranulomatous arteritis, and in 5 of 18 control aortas (28%) obtained at autopsy. The presence of VZV antigen in granulomatous aortitis was highly significant (P = .0001) as compared to control aortas, in which VZV antigen was never associated with pathology, indicating subclinical reactivation. VZV DNA was found in most aortas containing VZV antigen. The frequent clinical, radiological, and pathological aortic involvement in patients with giant cell arteritis correlates with the significant detection of VZV in granulomatous aortitis. PMID:27037084

  6. Clinical and biological differences between recurrent herpes simplex virus and varicella-zoster virus infections

    SciTech Connect

    Straus, S.E. )

    1989-12-01

    The major features that distinguish recurrent herpes simplex virus infections from zoster are illustrated in this article by two case histories. The clinical and epidemiologic features that characterize recurrent herpes simplex virus and varicella-zoster virus infections are reviewed. It is noted that herpesvirus infections are more common and severe in patients with cellular immune deficiency. Each virus evokes both humoral and cellular immune response in the course of primary infection. DNA hybridization studies with RNA probes labelled with sulfur-35 indicate that herpes simplex viruses persist within neurons, and that varicella-zoster virus is found in the satellite cells that encircle the neurons.

  7. Pathogenesis and Current Approaches to Control of Varicella-Zoster Virus Infections

    PubMed Central

    Gershon, Michael D.

    2013-01-01

    SUMMARY Varicella-zoster virus (VZV) was once thought to be a fairly innocuous pathogen. That view is no longer tenable. The morbidity and mortality due to the primary and secondary diseases that VZV causes, varicella and herpes zoster (HZ), are significant. Fortunately, modern advances, including an available vaccine to prevent varicella, a therapeutic vaccine to diminish the incidence and ameliorate sequelae of HZ, effective antiviral drugs, a better understanding of VZV pathogenesis, and advances in diagnostic virology have made it possible to control VZV in the United States. Occult forms of VZV-induced disease have been recognized, including zoster sine herpete and enteric zoster, which have expanded the field. Future progress should include development of more effective vaccines to prevent HZ and a more complete understanding of the consequences of VZV latency in the enteric nervous system. PMID:24092852

  8. Varicella-zoster virus glycoproteins B and E are major targets of CD4+ and CD8+ T cells reconstituting during zoster after allogeneic transplantation

    PubMed Central

    Kleemann, Patrick; Distler, Eva; Wagner, Eva M.; Thomas, Simone; Klobuch, Sebastian; Aue, Steffi; Schnürer, Elke; Schild, Hansjörg; Theobald, Matthias; Plachter, Bodo; Tenzer, Stefan; Meyer, Ralf G.; Herr, Wolfgang

    2012-01-01

    Background After allogeneic hematopoietic stem-cell transplantation patients are at increased risk for herpes zoster as long as varicella-zoster virus specific T-cell reconstitution is impaired. This study aimed to identify immunodominant varicella-zoster virus antigens that drive recovery of virus-specific T cells after transplantation. Design and Methods Antigens were purified from a varicella-zoster virus infected cell lysate by high-performance liquid chromatography and were identified by quantitative mass spectrometric analysis. To approximate in vivo immunogenicity for memory T cells, antigen preparations were consistently screened with ex vivo PBMC of varicella-zoster virus immune healthy individuals in sensitive interferon-γ ELISpot assays. Candidate virus antigens identified by the approach were genetically expressed in PBMC using electroporation of in vitro transcribed RNA encoding full-length proteins and were then analyzed for recognition by CD4+ and CD8+ memory T cells. Results Varicella-zoster virus encoded glycoproteins B and E, and immediate early protein 62 were identified in immunoreactive lysate material. Predominant CD4+ T-cell reactivity to these proteins was observed in healthy virus carriers. Furthermore, longitudinal screening in allogeneic stem-cell transplantation patients showed strong expansions of memory T cells recognizing glycoproteins B and E after onset of herpes zoster, while immediate early protein 62 reactivity remained moderate. Reactivity to viral glycoproteins boosted by acute zoster was mediated by both CD4+ and CD8+ T cells. Conclusions Our data demonstrate that glycoproteins B and E are major targets of varicella-zoster virus specific CD4+ and CD8+ T-cell reconstitution occurring during herpes zoster after allogeneic stem-cell transplantation. Varicella-zoster virus glycoproteins B and E might form the basis for novel non-hazardous zoster subunit vaccines suitable for immunocompromised transplant patients. PMID:22207687

  9. Molecular analysis of varicella vaccines and varicella-zoster virus from vaccine-related skin lesions.

    PubMed

    Thiele, Sonja; Borschewski, Aljona; Küchler, Judit; Bieberbach, Marc; Voigt, Sebastian; Ehlers, Bernhard

    2011-07-01

    To prevent complications that might follow an infection with varicella-zoster virus (VZV), the live attenuated Oka strain (V-Oka) is administered to children in many developed countries. Three vaccine brands (Varivax from Sanofi Pasteur MSD; Varilrix and Priorix-Tetra, both from Glaxo-Smith-Kline) are licensed in Germany and have been associated with both different degrees of vaccine effectiveness and adverse effects. To identify genetic variants in the vaccines that might contribute to rash-associated syndromes, single nucleotide polymorphism (SNP) profiles of variants from the three vaccines and rash-associated vaccine-type VZV from German vaccinees were quantitatively compared by PCR-based pyrosequencing (PSQ). The Varivax vaccine contained an estimated 3-fold higher diversity of VZV variants, with 20% more wild-type (wt) SNPs than Varilrix and Priorix-Tetra. These minor VZV variants in the vaccines were identified by analyzing cloned full-length open reading frame (ORF) orf62 sequences by chain termination sequencing and PSQ. Some of these sequences amplified from vaccine VZV were very similar or identical to those of the rash-associated vaccine-type VZV from vaccinees and were almost exclusively detected in Varivax. Therefore, minorities of rash-associated VZV variants are present in varicella vaccine formulations, and it can be concluded that the analysis of a core set of four SNPs is required as a minimum for a firm diagnostic differentiation of vaccine-type VZV from wt VZV. PMID:21562115

  10. Varicella zoster vaccines and their implications for development of HSV vaccines

    SciTech Connect

    Gershon, Anne A.

    2013-01-05

    Live attenuated vaccines to prevent varicella and zoster have been available in the US for the past 17 years, with a resultant dramatic decrease in varicella incidence and a predicted future decrease in the incidence of zoster. The pathogenesis and immune responses to varicella zoster virus (VZV) as well as the safety and effectiveness of VZV vaccines are reviewed. The lack of sterilizing immunity provided by VZV vaccines has not prevented them from being safe and effective. Virological and pathological information concerning parallels and differences between VZV and herpes simplex virus (HSV) are highlighted. Although VZV and HSV are distinct pathogens, they appear to have similarities in target organs and immunity that provide an expectation of a high likelihood for the success of vaccination against HSV, and predicted to be similar to that of VZV.

  11. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections.

    PubMed

    Sauerbrei, A

    2016-05-01

    Varicella-zoster virus (VZV), an important member of the Herpesviridae family, is the etiological agent of varicella as primary infection and zoster as recurrence. An outstanding feature is the lifelong viral latency in dorsal root and cranial nerve ganglia. Both varicella and zoster are worldwide widespread diseases that may be associated with significant complications. However, there is a broad spectrum of laboratory methods to diagnose VZV infections. In contrast to many other viral infections, antiviral treatment of VZV infections and their prevention by vaccination or passive immunoprophylaxis are well established in medical practice. The present manuscript provides an overview about the basic knowledge of VZV infections, their laboratory diagnosis, antiviral therapy, and the prevention procedures, especially in Germany. PMID:26873382

  12. Herpes Simplex Virus and Varicella-Zoster Virus.

    PubMed

    Levin, Myron J; Weinberg, Adriana; Schmid, D Scott

    2016-06-01

    The most common specimens from immunocompromised patients that are analyzed for detection of herpes simplex virus (HSV) or varicella-zoster virus (VZV) are from skin lesions. Many types of assays are applicable to these samples, but some, such as virus isolation and direct fluorescent antibody testing, are useful only in the early phases of the lesions. In contrast, nucleic acid (NA) detection methods, which generally have superior sensitivity and specificity, can be applied to skin lesions at any stage of progression. NA methods are also the best choice, and sometimes the only choice, for detecting HSV or VZV in blood, cerebrospinal fluid, aqueous or vitreous humor, and from mucosal surfaces. NA methods provide the best performance when reliability and speed (within 24 hours) are considered together. They readily distinguish the type of HSV detected or the source of VZV detected (wild type or vaccine strain). Nucleic acid detection methods are constantly being improved with respect to speed and ease of performance. Broader applications are under study, such as the use of quantitative results of viral load for prognosis and to assess the efficacy of antiviral therapy. PMID:27337486

  13. Immunogenicity of varicella zoster virus glycoprotein E DNA vaccine

    PubMed Central

    BAO, LIDAO; WEI, GUOMIN; GAN, HONGMEI; REN, XIANHUA; MA, RUILIAN; WANG, YI; LV, HAIJUN

    2016-01-01

    In the present study a eukaryotic expression vector of varicella zoster virus (VZV) glycoprotein E (gE) was constructed and enabled to express in COS7 cells. Furthermore, a specific immune response against the VZV gE eukaryotic expression plasmid was induced in BALB/c mice. The VZV gE gene was amplified using polymerase chain reaction (PCR) and cloned into a eukaryotic expression vector, pcDNA3.1. The recombinant vector was subsequently transfected into COS7 cells using a liposome transfection reagent. The recombinant protein was instantaneously expressed by the transfected cells, as detected by immunohistochemistry, and the recombinant pcDNA-VZV gE plasmid was subsequently used to immunize mice. Tissue expression levels were analyzed by reverse transcription-PCR. In addition, the levels of serum antibodies and spleen lymphocyte proliferation activity were investigated. The amplified target gene included the full-length gE gene (~2.7 kb), and the recombinant expression vector induced gE expression in COS7 cells. In addition, the expression plasmid induced sustained expression in vivo following immunization of mice. Furthermore, the plasmid was capable of inducing specific antibody production and effectively stimulating T cell proliferation. Effective humoral and cellular immunity was triggered in the mice immunized with the VZV gE eukaryotic expression vector. The results of the present study laid the foundation for future research into a VZV DNA vaccine. PMID:27168804

  14. Varicella-Zoster Virus–Specific Immune Responses in Elderly Recipients of a Herpes Zoster Vaccine

    PubMed Central

    Levin, M. J; Oxman, M. N; Zhang, J. H; Johnson, G. R; Stanley, H; Hayward, A. R; Caulfield, M. J; Irwin, M. R; Smith, J. G; Clair, J; Chan, I. S. F; Williams, H; Harbecke, R; Marchese, R; Straus, S. E; Gershon, A; Weinberg, A

    2008-01-01

    BackgroundA double-blind, placebo-controlled trial that involved 38,546 subjects ⩾60 years old demonstrated efficacy of a high-potency live-attenuated Oka/Merck varicella-zoster virus (VZV) vaccine. The trial included an immunology substudy to determine the relationship of VZV-specific immune responses to vaccination and clinical outcome MethodsThe immunology substudy enrolled 1395 subjects at 2 sites where blood samples obtained prior to vaccination, at 6 weeks after vaccination, and at 1, 2, and 3 years thereafter were tested for VZV-specific cell-mediated immunity (VZV-CMI) by γ-interferon ELISPOT and responder cell frequency assays and for VZV antibody by glycoprotein ELISA ResultsVZV-CMI and VZV antibodies were significantly increased in vaccine recipients at 6 weeks after vaccination. The vaccine-induced increases in VZV-CMI persisted during the 3 years of follow-up, although their magnitude decreased over time. The magnitude of these VZV-specific immune responses was greater in subjects 60–69 years old than in subjects ⩾70 years old ConclusionsThe zoster vaccine induced a significant increase in VZV-CMI and VZV antibody. The magnitude and duration of the boost in VZV-CMI in vaccine recipients and the relationship of this boost to age paralleled the clinical effects of the vaccine observed during the efficacy trial. These findings support the hypothesis that boosting VZV-CMI protects older adults against herpes zoster and postherpetic neuralgia PMID:18419349

  15. Issues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV).

    PubMed

    Kennedy, Peter G E

    2016-07-01

    Varicella zoster virus (VZV) is a ubiquitous neurotropic human herpesvirus. Primary infection usually causes varicella (chicken pox), after which virus becomes latent in ganglia along the entire neuraxis. Decades later, virus reactivates to produce herpes zoster (shingles), a painful dermatomally distributed vesicular eruption. Zoster may be further complicated by postherpetic neuralgia, VZV vasculopathy, myelitis, and segmental motor weakness. VZV reactivation has also been associated with giant cell arteritis. This overview discusses treatment of various conditions that often require both corticosteroids and antiviral drugs. Treatment for VZV-associated disease is often based on case reports and small studies rather than large-scale clinical trials. Issues that require resolution include the optimal duration of such combined therapy, more effective treatment for postherpetic neuralgia, whether some treatments should be given orally or intravenously, the widening spectrum of zoster sine herpete, and the role of antiviral therapy in giant cell arteritis. PMID:27032406

  16. Maculopapular rash presentation of febrile illness in an adult with Varicella zoster virus infection.

    PubMed

    Ojah, Siddhartha; Barani, Ramya; Sudhakar, M K; Ramakrishnan, S R; Srikanth, Padma

    2016-01-01

    Varicella zoster usually manifests as maculopapular rash (MPR), which later progresses to vesicle. It can also manifest as MPR without progression to the vesicle stage. This atypical manifestation is more common in adults and immunocompromised patients. A 30-year-old female presented with high-grade fever and rash over face and body for 5 days. She was diagnosed to have Varicella zoster virus (VZV) infection by positive VZV immunoglobulin M enzyme-linked immunosorbent assay and polymerase chain reaction. We present this case to increase awareness among clinicians on the atypical manifestations of VZV and prevent complications by early diagnosis. PMID:27510697

  17. Varicella-zoster virus associated encephalitis in a patient undergoing haemodialysis

    PubMed Central

    Al-Mula Abed, Yasser W.

    2015-01-01

    We describe an elderly gentleman with end stage renal disease on haemodialysis who presented with ophthalmic zoster infection and was discharged on oral acyclovir. He presented again a few days later with confusion and expressive dysphasia. Differential diagnosis was mainly between varicella-zoster virus (VZV) associated encephalitis versus acyclovir toxicity. Cerebrospinal fluid analysis confirmed the diagnosis of VZV associated encephalitis and the patient was treated with intravenous acyclovir and steroids with full recovery back to pre-admission neurological status. PMID:26865994

  18. In vitro system using human neurons demonstrates that varicella-zoster vaccine virus is impaired for reactivation, but not latency.

    PubMed

    Sadaoka, Tomohiko; Depledge, Daniel P; Rajbhandari, Labchan; Venkatesan, Arun; Breuer, Judith; Cohen, Jeffrey I

    2016-04-26

    Varicella-zoster virus (VZV) establishes latency in human sensory and cranial nerve ganglia during primary infection (varicella), and the virus can reactivate and cause zoster after primary infection. The mechanism of how the virus establishes and maintains latency and how it reactivates is poorly understood, largely due to the lack of robust models. We found that axonal infection of neurons derived from hESCs in a microfluidic device with cell-free parental Oka (POka) VZV resulted in latent infection with inability to detect several viral mRNAs by reverse transcriptase-quantitative PCR, no production of infectious virus, and maintenance of the viral DNA genome in endless configuration, consistent with an episome configuration. With deep sequencing, however, multiple viral mRNAs were detected. Treatment of the latently infected neurons with Ab to NGF resulted in production of infectious virus in about 25% of the latently infected cultures. Axonal infection of neurons with vaccine Oka (VOka) VZV resulted in a latent infection similar to infection with POka; however, in contrast to POka, VOka-infected neurons were markedly impaired for reactivation after treatment with Ab to NGF. In addition, viral transcription was markedly reduced in neurons latently infected with VOka compared with POka. Our in vitro system recapitulates both VZV latency and reactivation in vivo and may be used to study viral vaccines for their ability to establish latency and reactivate. PMID:27078099

  19. Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment.

    PubMed

    Grahn, Anna; Studahl, Marie

    2015-09-01

    Both varicella and herpes zoster that are caused by varicella-zoster virus (VZV), are associated with central nervous system disease. Since the introduction of polymerase chain reaction, the opportunity to detect the virus in cerebrospinal fluid (CSF) has improved dramatically. As a result VZV is diagnosed as one of the most common viruses causing CNS disease and it has become evident that this disease includes a wide spectrum of different CNS manifestations. The most evaluated CNS manifestations are encephalitis which is associated with both varicella and herpes zoster and, cerebellitis which occurs predominantly in children with varicella. Other manifestations have been less widely investigated. The incidence of cerebrovascular disease caused by VZV has been only scarcely studied and, in addition, some data indicate that vasculitis might also be involved in other VZV CNS manifestations such as herpes zoster-associated encephalitis. For this reason, VZV CNS infection must be suspected in several CNS syndromes and diagnostics should be based on CSF analysis for detection of VZV DNA by PCR and/or intrathecal antibody production. The prognosis is reported as favourable in children but few follow-up studies are available. Moreover, in adults, the prognosis is reported to be good in overall terms, but later studies indicate more serious neurological sequelae including cognition. Despite considerable mortality and morbidity, so far also in vaccinating countries, few treatment studies are available. Further treatment studies including assessments of neurological and cognitive sequelae, are warranted. PMID:26073188

  20. The Epidemiology of Herpes Zoster After Varicella Immunization Under Different Biological Hypotheses: Perspectives From Mathematical Modeling.

    PubMed

    Guzzetta, Giorgio; Poletti, Piero; Merler, Stefano; Manfredi, Piero

    2016-04-15

    The impact of varicella vaccination on the epidemiology of herpes zoster (HZ) critically depends on the mechanism of immunological boosting, through which reexposures to varicella-zoster virus are thought to reduce the individual risk of HZ development. However, the qualitative and quantitative dynamics of this process are largely unknown. Consequently, mathematical models evaluating immunization strategies need to rely on theoretical assumptions. Available varicella-zoster virus models can be classified in 3 main families according to the postulated effect of exogenous boosting: 1) progressive accumulation of immunity following repeated reexposures; 2) partial protection that wanes over time; or 3) full but temporary immunity against HZ. In this work, we review and compare quantitative predictions from the 3 modeling approaches regarding the effect of varicella immunization on HZ. All models predict a qualitatively similar, but quantitatively heterogeneous, transient increase of HZ incidence. In particular, novel estimates from the progressive immunity model predict the largest increase in natural HZ and the largest incidence of HZ cases from reactivation of the vaccine strain, which in the long term will likely outnumber prevaccination numbers. Our results reinforce the idea that a better understanding of HZ pathogenesis is required before further mass varicella immunization programs are set out. PMID:26994062

  1. Association of progressive outer retinal necrosis and varicella zoster encephalitis in a patient with AIDS.

    PubMed Central

    van den Horn, G J; Meenken, C; Troost, D

    1996-01-01

    BACKGROUND: A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection. METHODS: Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation. RESULTS: While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection. CONCLUSION: This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient. Images PMID:8976726

  2. Complete DNA sequences of two oka strain varicella-zoster virus genomes.

    PubMed

    Tillieux, Sueli L; Halsey, Wendy S; Thomas, Elizabeth S; Voycik, John J; Sathe, Ganesh M; Vassilev, Ventzislav

    2008-11-01

    Varicella-zoster virus (VZV) is a herpesvirus and is the causative agent of chicken pox (varicella) and shingles (herpes zoster). Active immunization against varicella became possible with the development of live attenuated varicella vaccine. The Oka vaccine strain was isolated in Japan from a child who had typical varicella, and it was then attenuated by serial passages in cell culture. Several manufacturers have obtained this attenuated Oka strain and, following additional passages, have developed their own vaccine strains. Notably, the vaccines Varilrix and Varivax are produced by GlaxoSmithKline Biologicals and Merck & Co., Inc., respectively. Both vaccines have been well studied in terms of safety and immunogenicity. In this study, we report the complete nucleotide sequence of the Varilrix (Oka-V(GSK)) and Varivax (Oka-V(Merck)) vaccine strain genomes. Their genomes are composed of 124,821 and 124,815 bp, respectively. Full genome annotations covering the features of Oka-derived vaccine genomes have been established for the first time. Sequence analysis indicates 36 nucleotide differences between the two vaccine strains throughout the entire genome, among which only 14 are involved in unique amino acid substitutions. These results demonstrate that, although Oka-V(GSK) and Oka-V(Merck) vaccine strains are not identical, they are very similar, which supports the clinical data showing that both vaccines are well tolerated and elicit strong immune responses against varicella. PMID:18787000

  3. A highly conserved epitope-vaccine candidate against varicella-zoster virus induces neutralizing antibodies in mice.

    PubMed

    Zhu, Rui; Liu, Jian; Chen, Chunye; Ye, Xiangzhong; Xu, Longfa; Wang, Wei; Zhao, Qinjian; Zhu, Hua; Cheng, Tong; Xia, Ningshao

    2016-03-18

    Varicella-zoster virus (VZV) is a highly infectious agent of varicella and herpes zoster (HZ). Vaccination is by far the most effective way to prevent these diseases. More safe, stable and efficient vaccines, such as epitope-based vaccines, now have been increasingly investigated by many researchers. However, only a few VZV neutralizing epitopes have been identified to date. We have previously identified a linear epitope between amino acid residues 121 and 135 of gE. In this study, we validated that this epitope is highly conserved amongst different VZV strains that covered five existing phylogenetic clades with an identity of 100%. We evaluated the immunogenicity of the recombinant hepatitis B virus core (HBc) virus-like particles (VLPs) which included amino acids (121-135). VZV-gE-specific antibodies were detected in immunized mouse serum using ELISA. The anti-peptide antiserum positively detected VZV via Western blot and immunofluorescent staining assays. More importantly, these peptides could neutralize VZV, indicating that these peptides represented neutralizing epitopes. These findings have important implications for the development of epitope-based protective VZV vaccines. PMID:26873057

  4. Varicella and herpes zoster vaccines: WHO position paper, June 2014--Recommendations.

    PubMed

    2016-01-01

    This article presents the World Health Organization's (WHO) recommendations for the use of varicella and herpes zoster vaccination from the WHO position paper on varicella and herpes zoster vaccines - June 2014, published in the Weekly Epidemiological Record [1]. This position paper summarizes the WHO position on the use of varicella and herpes zoster vaccines. The current document replaces the position paper on the use of varicella vaccines published in 1998 [2]. Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2014 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html. PMID:26723191

  5. Mechanisms of Varicella-Zoster Virus Neuropathogenesis in Human Dorsal Root Ganglia▿

    PubMed Central

    Reichelt, Mike; Zerboni, Leigh; Arvin, Ann M.

    2008-01-01

    Varicella-zoster virus (VZV) is a human alphaherpesvirus that infects sensory ganglia and reactivates from latency to cause herpes zoster. VZV replication was examined in human dorsal root ganglion (DRG) xenografts in mice with severe combined immunodeficiency using multiscale correlative immunofluorescence and electron microscopy. These experiments showed the presence of VZV genomic DNA, viral proteins, and virion production in both neurons and satellite cells within DRG. Furthermore, the multiscale analysis of VZV-host cell interactions revealed virus-induced cell-cell fusion and polykaryon formation between neurons and satellite cells during VZV replication in DRG in vivo. Satellite cell infection and polykaryon formation in neuron-satellite cell complexes provide mechanisms to amplify VZV entry into neuronal cell bodies, which is necessary for VZV transfer to skin in the affected dermatome during herpes zoster. These mechanisms of VZV neuropathogenesis help to account for the often severe neurologic consequences of herpes zoster. PMID:18256143

  6. Varicella-zoster meningitis with a late-onset of skin eruption.

    PubMed

    Sanguankeo, Anawin; Upala, Sikarin; Sornprom, Suthanya; Thamcharoen, Natanong

    2015-01-01

    Viral meningitis caused by varicella-zoster virus (VZV) is an uncommon neurological complication of herpes zoster. It may occur before or after the onset of the vesicular rash along the dermatomal distribution, which is the classic presentation of herpes zoster. We describe a case of a 51-year-old immunocompetent Caucasian man who presented with neck and severe right-sided facial pain. Eight days later, he had photophobia and papular rash on his forehead. Cerebrospinal fluid (CSF) examination confirmed aseptic meningitis and CSF PCR detected the presence of VZV DNA. Neurological complications of VZV infection, such as aseptic meningitis, may be difficult to diagnose and can cause delay in treatment, especially in cases with late onset of dermatological manifestations of herpes zoster. Definite diagnosis requires evidence of acute VZV infection in blood or cerebrospinal fluid. PMID:25691578

  7. Quantitation of Varicella-Zoster Virus DNA in Patients with Ramsay Hunt Syndrome and Zoster Sine Herpete

    PubMed Central

    Furuta, Yasushi; Ohtani, Fumio; Sawa, Hirofumi; Fukuda, Satoshi; Inuyama, Yukio

    2001-01-01

    Varicella-zoster virus (VZV) reactivation causes facial nerve palsy in Ramsay Hunt syndrome (RHS) and zoster sine herpete (ZSH) with and without zoster rash, respectively. In the present study, we analyzed the VZV DNA copy number in saliva samples from 25 patients with RHS and 31 patients with ZSH using a TaqMan PCR assay to determine differences in the viral load between the two diseases. VZV copy number in saliva peaked near the day of the appearance of zoster in patients with RHS. Consequently, VZV DNA was less frequently detected in patients with RHS who exhibited facial palsy several days after the appearance of zoster. These findings suggest that the VZV load in saliva samples reflects the kinetics of viral reactivation in patients with RHS. In addition, VZV DNA was equally detected in saliva from patients with RHS and ZSH, and there was no significant difference in the highest viral copy number between patients with RHS and those with ZSH. The VZV load does not appear to reflect a major difference between RHS and ZSH. PMID:11474003

  8. Autophagy and the Effects of Its Inhibition on Varicella-Zoster Virus Glycoprotein Biosynthesis and Infectivity

    PubMed Central

    Buckingham, Erin M.; Carpenter, John E.; Jackson, Wallen

    2014-01-01

    Autophagy and the effects of its inhibition or induction were investigated during the entire infectious cycle of varicella-zoster virus (VZV), a human herpesvirus. As a baseline, we first enumerated the number of autophagosomes per cell after VZV infection compared with the number after induction of autophagy following serum starvation or treatment with tunicamycin or trehalose. Punctum induction by VZV was similar in degree to punctum induction by trehalose in uninfected cells. Treatment of infected cells with the autophagy inhibitor 3-methyladenine (3-MA) markedly reduced the viral titer, as determined by assays measuring both cell-free virus and infectious foci (P < 0.0001). We next examined a virion-enriched band purified by density gradient sedimentation and observed that treatment with 3-MA decreased the amount of VZV gE, while treatment with trehalose increased the amount of gE in the same band. Because VZV gE is the most abundant glycoprotein, we selected gE as a representative viral glycoprotein. To further investigate the role of autophagy in VZV glycoprotein biosynthesis as well as confirm the results obtained with 3-MA inhibition, we transfected cells with ATG5 small interfering RNA to block autophagosome formation. VZV-induced syncytium formation was markedly reduced by ATG5 knockdown (P < 0.0001). Further, we found that both expression and glycan processing of VZV gE were decreased after ATG5 knockdown, while expression of the nonglycosylated IE62 tegument protein was unchanged. Taken together, our cumulative results not only documented abundant autophagy within VZV-infected cells throughout the infectious cycle but also demonstrated that VZV-induced autophagy facilitated VZV glycoprotein biosynthesis and processing. PMID:24198400

  9. Focal encephalitis following varicella-zoster virus reactivation without rash in a healthy immunized young adult.

    PubMed

    Halling, Geoffrey; Giannini, Caterina; Britton, Jeffrey W; Lee, Ricky W; Watson, Robert E; Terrell, Christine L; Parney, Ian F; Buckingham, Erin M; Carpenter, John E; Grose, Charles

    2014-09-01

    Herein we describe an episode of focal varicella-zoster virus (VZV) encephalitis in a healthy young man with neither rash nor radicular pain. The symptoms began with headaches and seizures, after which magnetic resonance imaging detected a single hyperintense lesion in the left temporal lobe. Because of the provisional diagnosis of a brain tumor, the lesion was excised and submitted for pathological examination. No tumor was found. But the tissue immunostained positively for VZV antigens, and wild-type VZV sequences were detected. In short, this case represents VZV reactivation, most likely in the trigeminal ganglion, in the absence of clinical herpes zoster. PMID:24604820

  10. Detection of varicella-zoster virus (VZV) DNA in clinical samples from patients with VZV by the polymerase chain reaction.

    PubMed Central

    Kido, S; Ozaki, T; Asada, H; Higashi, K; Kondo, K; Hayakawa, Y; Morishima, T; Takahashi, M; Yamanishi, K

    1991-01-01

    A polymerase chain reaction system for the detection of varicella-zoster virus was established. Of 25 nucleotides, 4 oligonucleotide pairs (regions of thymidine kinase, thymidylate synthetase, glycoprotein I, and immediate early gene) were synthesized. The first three oligonucleotide pairs could be used as primers on the basis of specific DNA amplification. Varicella-zoster virus DNA was amplified by this polymerase chain reaction system in 20 of 20 vesicle samples, 5 of 6 crusts, and 12 of 13 throat swabs collected from patients with clinical varicella. Images PMID:1847154

  11. Modulation of host CD59 expression by varicella-zoster virus in human xenografts in vivo.

    PubMed

    Wang, Wei; Wang, Xin; Yang, Lianwei; Fu, Wenkun; Pan, Dequan; Liu, Jian; Ye, Jianghui; Zhao, Qinjian; Zhu, Hua; Cheng, Tong; Xia, Ningshao

    2016-04-01

    Varicella-zoster virus (VZV) is the causative agent of both chickenpox (varicella) and shingles (zoster). VZV survives host defenses, even with an intact immune system, and disseminates in the host before causing disease. To date, several diverse immunomodulatory strategies used by VZV to undermine host immunity have been identified; however, few studies have addressed the complement evasion strategies used by this virus. Here, we show that expression of CD59, which is a key member of host regulators of complement activation (RCA), is significantly upregulated in response to VZV infection in human T cells and dorsal root ganglia (DRG) but not in human skin xenografts in SCID-hu mice in vivo. This is the first report demonstrating that VZV infection upregulates host CD59 expression in a tissue-specific manner in vivo, which may aid VZV in complement evasion and pathogenesis. PMID:26891237

  12. Insights into the function of tegument proteins from the varicella zoster virus.

    PubMed

    Wang, Wei; Cheng, Tong; Zhu, Hua; Xia, NingShao

    2015-08-01

    Chickenpox (varicella) is caused by primary infection with varicella zoster virus (VZV), which can establish long-term latency in the host ganglion. Once reactivated, the virus can cause shingles (zoster) in the host. VZV has a typical herpesvirus virion structure consisting of an inner DNA core, a capsid, a tegument, and an outer envelope. The tegument is an amorphous layer enclosed between the nucleocapsid and the envelope, which contains a variety of proteins. However, the types and functions of VZV tegument proteins have not yet been completely determined. In this review, we describe the current knowledge on the multiple roles played by VZV tegument proteins during viral infection. Moreover, we discuss the VZV tegument protein-protein interactions and their impact on viral tissue tropism in SCID-hu mice. This will help us develop a better understanding of how the tegument proteins aid viral DNA replication, evasion of host immune response, and pathogenesis. PMID:26208824

  13. Varicella-Zoster Virus–Specific Immune Responses to Herpes Zoster in Elderly Participants in a Trial of a Clinically Effective Zoster Vaccine

    PubMed Central

    Zhang, Jane H.; Oxman, Michael N.; Johnson, Gary R.; Hayward, Anthony R.; Caulfield, Michael J.; Irwin, Michael R.; Clair, James; Smith, Jeffrey G.; Stanley, Harold; Marchese, Rocio D.; Harbecke, Ruth; Williams, Heather M.; Chan, Ivan S. F.; Arbeit, Robert D.; Gershon, Anne A.; Schödel, Florian; Morrison, Vicki A.; Kauffman, Carol A.; Straus, Steve E.; Schmader, Kenneth E.; Davis, Larry E.; Levin, Myron J.

    2009-01-01

    BackgroundThe objectives of this study were to evaluate the association between varicella-zoster virus (VZV)–specific humoral and cell-mediated immunity (CMI) to herpes zoster (HZ) and protection against HZ morbidity and to compare immune responses to HZ and zoster vaccine MethodsIn 981 elderly persons who developed HZ during a zoster vaccine efficacy trial (321 vaccinees and 660 placebo recipients) and 1362 without HZ (682 vaccinees and 680 placebo recipients), CMI was measured by VZV responder cell frequency and interferon-γ enzyme-linked immunospot, and antibodies were measured by VZV enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA) ResultsRobust VZV CMI at HZ onset correlated with reduced HZ morbidity, whereas VZV gpELISA titers did not. Three weeks after HZ onset, gpELISA titers were highest in those with more severe HZ and were slightly increased in placebo recipients (compared with zoster vaccine recipients) and in older individuals. VZV CMI responses to HZ were similar in zoster vaccine and placebo recipients and were not affected by demographic characteristics or antiviral therapy, except for responder cell frequency at HZ onset, which decreased with age. When responses to zoster vaccine and HZ could be compared, VZV CMI values were similar, but antibody titers were lower ConclusionsHigher VZV CMI at HZ onset was associated with reduced HZ severity and less postherpetic neuralgia. Higher antibody titers were associated with increased HZ severity and occurrence of postherpetic neuralgia. HZ and zoster vaccine generated comparable VZV CMI PMID:19712037

  14. High-Resolution Vessel Wall Magnetic Resonance Imaging in Varicella-Zoster Virus Vasculitis.

    PubMed

    Tsivgoulis, Georgios; Lachanis, Stefanos; Magoufis, Georgios; Safouris, Apostolos; Kargiotis, Odysseas; Stamboulis, Elefterios

    2016-06-01

    Varicella-zoster virus vasculopathy is a rare but potentially treatable condition. Diagnosis has been based on angiography, brain magnetic resonance imaging (MRI), and cerebrospinal fluid analysis. High-resolution vessel wall MRI may aid to the diagnosis by differentiating inflammation from other vessel wall pathologies. We present the characteristic MRI findings of this condition in a young patient presenting with ischemic stroke. PMID:27067878

  15. Dendritic cells as Achilles' heel and Trojan horse during varicella zoster virus infection.

    PubMed

    Schönrich, Günther; Raftery, Martin J

    2015-01-01

    Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently establishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems' Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article. PMID:26005438

  16. Dendritic cells as Achilles’ heel and Trojan horse during varicella zoster virus infection

    PubMed Central

    Schönrich, Günther; Raftery, Martin J.

    2015-01-01

    Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently establishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems’ Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article. PMID:26005438

  17. The risk of varicella zoster virus infection in multiple sclerosis patients treated with fingolimod.

    PubMed

    Tanaka, Masami

    2016-04-28

    Fingolimod, a sphingosine-1-phosphate receptor modulator, inhibits the egress of CCR7-positive lymphocytes, including encephalitogenic lymphocytes, from lymph nodes and may sometimes cause lymphopenia. A recent study reported that varicella zoster virus reactivation occurred in the saliva of 20% of multiple sclerosis (MS) patients treated with fingolimod. I compared the risk of developing herpes zoster between 32 MS patients treated with fingolimod (FTY-MS) and 45 patients, including those with neuromyelitis optica spectrum disorder, horizontal hemianopsia without anti-aquaporin-4 antibodies, and myelitis with anti-myelin oligodendrocyte glycoprotein antibodies, treated with tacrolimus (TCR-NMO). The risk of developing herpes zoster in FTY-MS (40/1,000 patient-years) was significantly higher than that in TCR-NMO (6/1,000 patient-years) (P < 0.0001, odds ratio: 6.90). The incidence of herpes zoster of patients with rheumatoid arthritis treated with Tofacitinib in Asian countries has been shown to be higher than those of patients in the United States or European countries. It may be better to pay more attention to develop herpes zoster in Japanese MS patients treated with fingolimod. PMID:27010095

  18. Reactivation of varicella-zoster virus in delayed facial palsy after dental treatment and oro-facial surgery.

    PubMed

    Furuta, Y; Ohtani, F; Fukuda, S; Inuyama, Y; Nagashima, K

    2000-09-01

    In rare cases, acute peripheral facial palsy occurs several days after dental treatment and oro-facial surgery. Surgical procedures have been known to trigger reactivation of varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The present study examined eight patients who exhibited delayed facial palsy after dental treatment or oro-facial surgery. Ramsay Hunt syndrome was diagnosed in three patients and varicella-zoster virus (VZV) reactivation without zoster lesions (zoster sine herpete) was diagnosed in three patients either by PCR or serological assay. Therefore, VZV reactivation was detected in 75% (6 of 8) of patients who exhibited delayed facial palsy after dental or oro-facial treatment. The results suggest that VZV reactivation is a major cause of delayed facial palsy after dental treatment or oro-facial surgery. PMID:10935987

  19. Varicella zoster virus (VZV) infects and establishes latency in enteric neurons

    PubMed Central

    Chen, Jason J.; Gershon, Anne A.; Li, Zhishan; Cowles, Robert A.; Gershon, Michael D.

    2012-01-01

    Case reports have linked varicella-zoster virus (VZV) to gastrointestinal disorders, including severe abdominal pain preceding fatal varicella and acute colonic pseudoobstruction (Ogilvie’s syndrome). Because we had previously detected DNA and transcripts encoding latency–associated VZV gene products in the human gut, we sought to determine whether latent VZV is present in the human enteric nervous system (ENS) and, if so, to identify the cells in which it is located and its route to the bowel. Neither DNA, nor transcripts encoding VZV gene products, could be detected in resected gut from any of 7 control children (< 1 year old) who had not received the varicella vaccine or experienced varicella; however, VZV DNA and transcripts were each found to be present in resected bowel from 6/6 of children with a past history of varicella and in that of 6/7 of children who received the varicella vaccine. Both wild-type (WT) and vaccine-type (vOka) VZV thus establish latent infection in human gut. To determine routes by which VZV might gain access to the bowel, we injected guinea pigs with human or guinea pig lymphocytes expressing green fluorescent protein (GFP) under the control of the VZV ORF66 gene (VZVOKA66.GFP). GFP-expressing enteric neurons were found throughout the bowel within 2 days and continued to be present for greater than 6 weeks. DNA encoding VZV gene products also appeared in enteric and dorsal root ganglion (DRG) neurons following intradermal administration of WT-VZV and in enteric neurons after intradermal injection of VZVOKA66.GFP; moreover, a small number of guinea pig DRG neurons were found to project both to the skin and the intraperitoneal viscera. Viremia, in which lymphocytes carry VZV, or axonal transport from DRG neurons infected through their epidermal projections are thus each potential routes that enable VZV to gain access to the ENS. PMID:22190254

  20. Varicella zoster virus-associated morbidity and mortality in Africa: a systematic review protocol

    PubMed Central

    Hussey, Hannah S; Abdullahi, Leila H; Collins, Jamie E; Muloiwa, Rudzani; Hussey, Gregory D; Kagina, Benjamin M

    2016-01-01

    Introduction Varicella zoster virus (VZV) causes varicella (chicken pox) and herpes zoster (shingles). Worldwide, these diseases are associated with significant morbidity. Most of the epidemiological data on VZV come from high income countries. There are few data on VZV in Africa, where tropical climates and high HIV/AIDS prevalence rates are expected to impact the epidemiology of VZV. Safe and effective vaccinations for both varicella and herpes zoster exist, but are not routinely used in Africa. There are very few data available on VZV disease burden in Africa to guide the introduction of these vaccines on the continent. Our aim is to conduct a systematic review of the VZV-associated morbidity and mortality in Africa, which will provide critical information that could be used to develop vaccination policies against these diseases in Africa. Methods and analysis Electronic databases will be searched and all studies published after 1974 that meet predefined criteria will be assessed. The primary outcomes for the study are VZV incidence/prevalence, hospitalisation rates and total death rates. The secondary outcome for this study is the proportion of VZV hospitalisations and/or deaths associated with HIV/AIDS. Two reviewers will screen the titles and abstracts, and then independently review the full texts, to determine if studies are eligible for inclusion. A risk of bias and quality assessment tool will be used to score all included studies. Following standardised data extraction, a trend analysis using R-programming software will be conducted to investigate the trend of VZV. Depending on the characteristics of included studies, subgroup analyses will be performed. This review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Ethics and dissemination As this is a protocol for a systematic review, which will use already published data, no ethics approval is required. Findings will be disseminated

  1. Disseminated Varicella-Zoster Virus After Vaccination in an Immunocompetent Patient.

    PubMed

    Scotch, Allison H; Hoss, Elika; Orenstein, Robert; Budavari, Adriane I

    2016-06-01

    Severe adverse events associated with varicella-zoster virus (VZV) vaccination are rare. The authors describe a 53-year-old woman with no known immunodeficiency who presented with diffuse pruritic rash 17 days after receiving the varicella virus vaccine live. She had a low level of white blood cells and received a diagnosis of thrombocytopenia with elevated aminotransferase levels. Punch biopsy demonstrated positive VZV immunostaining and viral culture positive for VZV. After treatment with acyclovir, her rash improved and her white blood cell and platelet counts returned to normal. Mild reactions to vaccines including localized rash are well recognized. Disseminated infections have been reported in patients with congenital and acquired immunodeficiency, but systemic postvaccination infections are rare in immunocompetent adults. This case highlights the importance of recognizing adverse events associated with vaccination. PMID:27214778

  2. Multiple Apical Radiolucencies and External Cervical Resorption Associated with Varicella Zoster Virus: A Case Report.

    PubMed

    Patel, Kreena; Schirru, Elia; Niazi, Sadia; Mitchell, Philip; Mannocci, Francesco

    2016-06-01

    Varicella zoster virus (VZV) is responsible for the primary infection chickenpox. After the initial infection, it remains latent but can reactivate, resulting in shingles (herpes zoster). Previous reports have implicated VZV in the pathogenesis of apical periodontitis, but the involvement of the virus has not been investigated fully. The present case describes a patient who suffered from a severe episode of shingles and subsequently developed periapical radiolucencies of all the teeth in the affected nerve distribution. Molecular and culture techniques showed the presence of VZV DNA in the root canal system in the absence of bacteria. This confirms that VZV can cause localized pulp necrosis and apical periodontitis. The lesions healed after endodontic treatment, implying chemomechanical debridement using sodium hypochlorite irrigation and a calcium hydroxide interim dressing may be effective against the virus. PMID:27133503

  3. Varicella-Zoster Virus Open Reading Frame 48 Encodes an Active Nuclease

    PubMed Central

    Mueller, Niklaus H.; Gilden, Don

    2013-01-01

    Based on a DNA sequence and relative genomic position similar to those other herpesviruses, varicella-zoster virus (VZV) open reading frame 48 (ORF48) is predicted to encode an alkaline nuclease. Here we report the cloning, expression, purification, and characterization of recombinant VZV ORF48 protein and a VZV ORF48 point mutation (T172P). Protein encoded by wild-type ORF48, but not mutant protein, displayed both endo- and exonuclease activity, identifying ORF48 as a potential therapeutic target in VZV disease since efficient viral replication requires viral nuclease activity. PMID:23966396

  4. Time trends in pediatric Herpes zoster hospitalization rate after Varicella immunization.

    PubMed

    Critselis, Elena; Theodoridou, Kalliopi; Alexopoulou, Zoi; Theodoridou, Maria; Papaevangelou, Vassiliki

    2016-06-01

    Herpes zoster (HZ) is an emerging concern for public health officials. The aim of this study was to determine whether universal Varicella immunization implemented in 2004 had an impact on HZ hospitalization in immunocompetent children in Greece. All HZ hospitalizations were recorded during the period 1999-2011. The overall attributable hospitalization rate was 13.89 cases/1000 hospital admissions (95%CI: 11.69-16.38 cases/1000 hospital admissions). HZ hospitalization rate remained unchanged during the study period. These data provide a basis for monitoring HZ hospitalization rate among children following universal toddler immunization. PMID:27322864

  5. Acute liver failure due to Varicella zoster virus infection after lung transplantation: a case report.

    PubMed

    Verleden, G M; Vos, R; Van Raemdonck, D E; Laleman, W; Vanaudenaerde, B M

    2012-06-01

    Most adults are Varicella zoster virus (VZV)-positive at the age of 20 years. Some, however, remain antibody-negative and may develop primary chicken pox during adulthood. We report a patient with Williams-Campbell syndrome who underwent double-lung transplantation while being VZV-negative. One year after the successful procedure, he was admitted with fulminant hepatic failure and some cutaneous vesicles in his face. Despite a rapid diagnosis of VZV infection and treatment with acyclovir, his situation deteriorated within 24 hours and while awaiting an urgent liver transplantation, he developed multiple organ failure and died. PMID:22664036

  6. Expression of varicella-zoster virus and herpes simplex virus in normal human trigeminal ganglia

    SciTech Connect

    Vafai, A.; Wellish, M.; Devlin, M.; Gilden, D.H. ); Murray, R.S. Veterans Administration Medical Center, Denver, CO )

    1988-04-01

    Lysates of radiolabeled explants from four human trigeminal ganglia were immunoprecipitated with antibodies to varicella-zoster virus (VZV) and to herpes simplex virus. Both herpes simplex virus- and VZV-specific proteins were detected in lysates of all four ganglia. Absence of reactivity in ganglion explants with monoclonal antibodies suggested that herpes simplex virus and VZV were not reactivated during the culture period. In situ hybridization studies demonstrated the presence of RNA transcripts from the VZV immediate early gene 63. This approach to the detection of herpes simplex virus and VZV expression in human ganglia should facilitate analysis of viral RNA and proteins in human sensory ganglia.

  7. Burning mouth syndrome associated with varicella zoster virus.

    PubMed

    Nagel, Maria A; Gilden, Don

    2016-01-01

    We present two cases of burning mouth syndrome (BMS)-of 8-month duration in a 61-year-old woman and of 2-year duration in a 63-year-old woman-both associated with increased levels of antivaricella zoster virus (VZV) IgM antibodies in serum and with pain that improved with antiviral treatment. Combined with our previous finding of BMS due to herpes simplex virus type 1 (HSV-1) infection, we recommend evaluation of patients with BMS not only for VZV or HSV-1 DNA in the saliva, but also for serum anti-VZV and anti-HSV-1 IgM antibodies. Both infections are treatable with oral antiviral agents. PMID:27382016

  8. Superior Orbital Fissure Syndrome and Ophthalmoplegia Caused by Varicella Zoster Virus with No Skin Eruption in a Patient Treated with Tumor Necrosis Alpha Inhibitor.

    PubMed

    Jensen, Helene; Thomsen, Sidsel Thorup; Hansen, Stine Scott; Munksgaard, Signe Bruun; Lindelof, Mette

    2015-01-01

    Varicella zoster virus lies dormant in the dorsal root ganglia after symptomatic chicken pox infection, usually in childhood. If the virus reactivates in the trigeminal ganglia, it can cause varicella zoster ophthalmicus, which can have severe ocular complications. We report a case of a 73-year-old woman in severe immunosuppression due to treatment with mycophenolate mofetil, glucocorticosteroids and a tumor necrosis factor alpha inhibitor. The reactivation caused superior orbital fissure syndrome, which has only rarely been described in relation to varicella zoster virus reactivation. In our case, the syndrome was seen along with severe encephalitis. PMID:26600786

  9. Superior Orbital Fissure Syndrome and Ophthalmoplegia Caused by Varicella Zoster Virus with No Skin Eruption in a Patient Treated with Tumor Necrosis Alpha Inhibitor

    PubMed Central

    Jensen, Helene; Thomsen, Sidsel Thorup; Hansen, Stine Scott; Munksgaard, Signe Bruun; Lindelof, Mette

    2015-01-01

    Varicella zoster virus lies dormant in the dorsal root ganglia after symptomatic chicken pox infection, usually in childhood. If the virus reactivates in the trigeminal ganglia, it can cause varicella zoster ophthalmicus, which can have severe ocular complications. We report a case of a 73-year-old woman in severe immunosuppression due to treatment with mycophenolate mofetil, glucocorticosteroids and a tumor necrosis factor alpha inhibitor. The reactivation caused superior orbital fissure syndrome, which has only rarely been described in relation to varicella zoster virus reactivation. In our case, the syndrome was seen along with severe encephalitis. PMID:26600786

  10. Twenty Years of Medically-Attended Pediatric Varicella and Herpes Zoster in Ontario, Canada: A Population-Based Study

    PubMed Central

    Wormsbecker, Anne E.; Wang, Jun; Rosella, Laura C.; Kwong, Jeffrey C.; Seo, Chi Yon; Crowcroft, Natasha S.; Deeks, Shelley L.

    2015-01-01

    Objective To determine if reductions in medically-attended pediatric varicella and herpes zoster occurred in Ontario, Canada, after publicly-funded varicella immunization was implemented in 2004. Methods For fiscal years (FY) 1992-2011, we examined data on varicella and herpes zoster physician office visits, emergency department (ED) visits, hospitalizations (including for varicella-associated skin and soft tissue infections [SSTI]), and intensive care unit (ICU) admissions, among those aged <18 years. The pre-vaccine, privately-available, and vaccine program eras were FY1992-1998, FY1999-2003, and FY2004-2011, respectively. We used Poisson regressionand Kruskal-Wallis tests (all at the p<0.05 level of significance), and compared rates using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Results Incidence of varicella office visits declined over the study period from a high of 25.1/1,000 in FY1994 to a low of 3.2/1,000 in FY2011. ED visits and hospitalizations followed similar patterns of decreasing rates later in the study period. IRRs comparing the vaccine program versus pre-vaccine eras were 0.29 (95%CI: 0.26-0.32) for office visits, 0.29 (95%CI: 0.21-0.40) for ED visits, and 0.41 (95%CI: 0.10-1.69) for hospitalizations. Annual declines in varicella office visits were 7.7%, 9.1%, 8.4%, and 8.4% per year among children aged <1 year, 1-4 years, 5-11 years, and ≥12 years, respectively (all p<0.001). Age-specific rates of varicella-associated SSTI declined significantly among children <12 years (p<0.001) and rates of ICU admissions decreased significantly for children <1 year (p = 0.02). (p<0.001) over the study period. For children aged 5-17 years, herpes zoster office visits decreased whereas ED visits increased (both p<0.001) and there was a small, non-significant (p = 0.07), decrease in hospitalizations. Conclusion Medically-attended varicella decreased during the study period, particularly since varicella vaccine was publicly-funded. Results

  11. Varicella-Zoster Virus in Perth, Western Australia: Seasonality and Reactivation

    PubMed Central

    Korostil, Igor A.; Regan, David G.

    2016-01-01

    Background Identification of the factors affecting reactivation of varicella-zoster virus (VZV) largely remains an open question. Exposure to solar ultra violet (UV) radiation is speculated to facilitate reactivation. Should the role of UV in reactivation be significant, VZV reactivation patterns would generally be expected to be synchronous with seasonal UV profiles in temperate climates. Methods We analysed age and gender specific VZV notification time series data from Perth, Western Australia (WA). This city has more daily sunshine hours than any other major Australian city. Using the cosinor and generalized linear models, we tested these data for seasonality and correlation with UV and temperature. Results We established significant seasonality of varicella notifications and showed that while herpes-zoster (HZ) was not seasonal it had a more stable seasonal component in males over 60 than in any other subpopulation tested. We also detected significant association between HZ notifications and UV for the entire Perth population as well as for females and males separately. In most cases, temperature proved to be a significant factor as well. Conclusions Our findings suggest that UV radiation may be important for VZV reactivation, under the assumption that notification data represent an acceptably accurate qualitative measure of true VZV incidence. PMID:26963841

  12. The Seroepidemiology of Varicella Zoster Virus (VZV) in Different Age Groups in Tehran, Iran.

    PubMed

    Sharifi, Zohreh; Emadi Ghanjin, Sekyneh

    2005-06-01

    Varicella zoster virus (VZV), the causative agent of chicken pox and shingles, can cause severe systemic infections of the CNS and the respiratory tract in immunocompetent individuals as well as in immunocompromized patients.The aim of this cross-sectional study was to assess the prevalence of antibody Varicella zoster virus in different age groups.The enzyme linked immunosorbent assay (ELISA) method was used to assess the presence of anti -VZV antibody.A total of 635 serum samples were collected. Age specific prevalence of IgG antibody to VZV showed a progressive increase with age in both males and females. The overall seroprevalence rate was 83.6%. Prevalence of antibodies was 59.7% in the age group of less than 10 years, 60.4 % in 10-14 years, 87.5 % in 15-19 years, 88 % in 20-24 years, 89.4 % in 25-29 years and 87.9 % in 30-39 years.The data show that children should be considered as a target group for prevention programs against VZV infection. PMID:17301429

  13. Current and future effects of varicella and herpes zoster vaccination in Germany - Insights from a mathematical model in a country with universal varicella vaccination.

    PubMed

    Horn, Johannes; Karch, André; Damm, Oliver; Kretzschmar, Mirjam E; Siedler, Anette; Ultsch, Bernhard; Weidemann, Felix; Wichmann, Ole; Hengel, Hartmut; Greiner, Wolfgang; Mikolajczyk, Rafael T

    2016-07-01

    Varicella zoster virus (VZV) is primarily known for causing varicella in childhood, but can reactivate again as herpes zoster (HZ) after a period of latency, mainly in persons older than 50 years. Universal varicella vaccination was introduced in Germany in 2004, while HZ vaccination has not been recommended yet. We aimed to quantify the potential long-term effects of universal childhood varicella vaccination and HZ vaccination of the elderly on varicella and HZ incidence in Germany over a time horizon of 100 years, using a transmission model calibrated to pre-vaccination data and validated against early post-vaccination data. Using current vaccination coverage rates of 87% (64%) with one (two) varicella vaccine dose(s), the model predicts a decrease in varicella cases by 89% for the year 2015. In the long run, the incidence reduction will stabilize at about 70%. Under the assumption of the boosting hypothesis of improved HZ protection caused by exposure to VZV, the model predicts a temporary increase in HZ incidence of up to 20% for around 50 years. HZ vaccination of the elderly with an assumed coverage of 20% has only limited effects in counteracting this temporary increase in HZ incidence. However, HZ incidence is shown to decrease in the long-term by 58% as vaccinated individuals get older and finally reach age-classes with originally high HZ incidence. Despite substantial uncertainties around several key variables, the model's results provide valuable insights that support decision-making regarding national VZV vaccination strategies. PMID:26835890

  14. The simian varicella virus genome contains an invertible 665 base pair terminal element that is absent in the varicella zoster virus genome

    PubMed Central

    Mahalingam, Ravi; Gray, Wayne L.

    2007-01-01

    Simian varicella virus (SVV) causes chickenpox in monkeys, establishes latency, and reactivates to produce zoster thus providing a model to study human varicella zoster virus (VZV) infection. Sequence analysis of a recombinant cosmid clone containing the left end of the SVV genome revealed a 665 base pair (bp) segment that is absent in VZV DNA. This segment inverts and contains 507 bp of unique sequences flanked on either side by 79 bp inverted repeats, making the SVV genome to be 124,785 bp in size. Part of the inverted repeat sequence (64 bp) is also present at the junction of the long and short segments of the SVV genome. The terminal DNA sequences are conserved among different SVV isolates and present in tissues from infected monkeys. The terminal region is transcriptionally active and is also present in the genomes of other animal varicelloviruses, but absent in the VZV genome. PMID:17555785

  15. An analysis of infection control of varicella-zoster virus infections in Addenbrooke's Hospital Cambridge over a 5-year period, 1987-92.

    PubMed Central

    Wreghitt, T. G.; Whipp, J.; Redpath, C.; Hollingworth, W.

    1996-01-01

    This prospective study analyses infections with varicella-zoster virus (VZV) in Addenbrooke's Hospital, Cambridge during 1987-92 and examines the spread of infection. In total, 93 patients and staff experienced VZV infection. Twenty-one patients had varicella and 49 experienced zoster. None of 101 patients and 1 of 625 staff members in contact with varicella cases acquired infection. By contrast, 2 of 227 patients, and 5 of 1039 staff in contact with zoster cases acquired varicella. One out of 28 (3.6%) VZV antibody-negative patients and staff in contact with varicella acquired infection, compared with 5 out of 29 (17.2%) VZV antibody-negative patients and staff in contact with zoster. Thus, zoster was found to be a more frequent cause of nosocomial infection than varicella. Fourteen members of staff had VZV infection during the study period. One of 99 patients and none of 389 staff members in contact with these cases developed varicella. The cost of dealing with infection control for VZV infections in our hospital is estimated to be Pounds 714 per patient case and a total of Pounds 13,204 per year. PMID:8760965

  16. The Effects of School Holidays on Transmission of Varicella Zoster Virus, England and Wales, 1967–2008

    PubMed Central

    Jackson, Charlotte; Mangtani, Punam; Fine, Paul; Vynnycky, Emilia

    2014-01-01

    Background Changes in children’s contact patterns between termtime and school holidays affect the transmission of several respiratory-spread infections. Transmission of varicella zoster virus (VZV), the causative agent of chickenpox, has also been linked to the school calendar in several settings, but temporal changes in the proportion of young children attending childcare centres may have influenced this relationship. Methods We used two modelling methods (a simple difference equations model and a Time series Susceptible Infectious Recovered (TSIR) model) to estimate fortnightly values of a contact parameter (the per capita rate of effective contact between two specific individuals), using GP consultation data for chickenpox in England and Wales from 1967–2008. Results The estimated contact parameters were 22–31% lower during the summer holiday than during termtime. The relationship between the contact parameter and the school calendar did not change markedly over the years analysed. Conclusions In England and Wales, reductions in contact between children during the school summer holiday lead to a reduction in the transmission of VZV. These estimates are relevant for predicting how closing schools and nurseries may affect an outbreak of an emerging respiratory-spread pathogen. PMID:24932994

  17. Varicella zoster CNS vascular complications. A report of four cases and literature review.

    PubMed

    Chiang, Francisco; Panyaping, Theeraphol; Tedesqui, Gustavo; Sossa, Daniel; Costa Leite, Claudia; Castillo, Mauricio

    2014-06-01

    This study explored the neurologic vascular complications of varicella zoster virus (VZV). We describe four patients presenting at our institution with neurologic involvement by VZV. MR and MRA studies of the intracranial arterial circulation in the head were read by board-certified radiologists using standard clinical procedures. On MRI, three patients had acute infarcts and in two instances irregularities and narrowings of vessels were visible. Many of these complications are recognized to be due to a vasculopathy affecting small or large vessels and resulting in cerebral infarctions and rarely hemorrhages. The pattern of cerebral infarction and vascular abnormalities is not specific and resembles those of vasculitis/vasculopathy from other causes. The central nervous system (CNS) vascular complications of VZV should be considered in the patients with simultaneous primary or prior VZV infection whose imaging studies show cerebral infarction and/or vasculitic appearing intracranial arteries. PMID:24976200

  18. Varicella-zoster virus distribution in Ramsay Hunt syndrome revealed by polymerase chain reaction.

    PubMed

    Murakami, S; Nakashiro, Y; Mizobuchi, M; Hato, N; Honda, N; Gyo, K

    1998-03-01

    The pathogenesis of facial nerve paralysis and vestibulo-cochlear dysfunction of Ramsay Hunt syndrome remains unclear as varicella-zoster virus (VZV) has not been demonstrated in the lesions. Using the polymerase chain reaction, we detected VZV genomes not only in the vesicles on the auricles or oral cavity but also in the facial nerve sheath, middle ear mucosa and cerebrospinal fluid from patients with Ramsay Hunt syndrome. The VZV genome was undetectable in the same kinds of clinical samples obtained from control patients with facial nerve paralysis of other etiologies. The results indicated that VZV spreads widely in the neural components, mucocutaneous tissue and cerebrospinal fluid. The present study will facilitate better understanding of the pathogenesis of facial nerve paralysis, vertigo, hearing impairment and other cranial nerve dysfunction of Ramsay Hunt syndrome. PMID:9583779

  19. Sialic Acids on Varicella-Zoster Virus Glycoprotein B Are Required for Cell-Cell Fusion*

    PubMed Central

    Suenaga, Tadahiro; Matsumoto, Maki; Arisawa, Fuminori; Kohyama, Masako; Hirayasu, Kouyuki; Mori, Yasuko; Arase, Hisashi

    2015-01-01

    Varicella-zoster virus (VZV) is a member of the human Herpesvirus family that causes varicella (chicken pox) and zoster (shingles). VZV latently infects sensory ganglia and is also responsible for encephalomyelitis. Myelin-associated glycoprotein (MAG), a member of the sialic acid (SA)-binding immunoglobulin-like lectin family, is mainly expressed in neural tissues. VZV glycoprotein B (gB) associates with MAG and mediates membrane fusion during VZV entry into host cells. The SA requirements of MAG when associating with its ligands vary depending on the specific ligand, but it is unclear whether the SAs on gB are involved in the association with MAG. In this study, we found that SAs on gB are essential for the association with MAG as well as for membrane fusion during VZV infection. MAG with a point mutation in the SA-binding site did not bind to gB and did not mediate cell-cell fusion or VZV entry. Cell-cell fusion and VZV entry mediated by the gB-MAG interaction were blocked by sialidase treatment. N-glycosylation or O-glycosylation inhibitors also inhibited the fusion and entry mediated by gB-MAG interaction. Furthermore, gB with mutations in N-glycosylation sites, i.e. asparagine residues 557 and 686, did not associate with MAG, and the cell-cell fusion efficiency was low. Fusion between the viral envelope and cellular membrane is essential for host cell entry by herpesviruses. Therefore, these results suggest that SAs on gB play important roles in MAG-mediated VZV infection. PMID:26105052

  20. Sialic Acids on Varicella-Zoster Virus Glycoprotein B Are Required for Cell-Cell Fusion.

    PubMed

    Suenaga, Tadahiro; Matsumoto, Maki; Arisawa, Fuminori; Kohyama, Masako; Hirayasu, Kouyuki; Mori, Yasuko; Arase, Hisashi

    2015-08-01

    Varicella-zoster virus (VZV) is a member of the human Herpesvirus family that causes varicella (chicken pox) and zoster (shingles). VZV latently infects sensory ganglia and is also responsible for encephalomyelitis. Myelin-associated glycoprotein (MAG), a member of the sialic acid (SA)-binding immunoglobulin-like lectin family, is mainly expressed in neural tissues. VZV glycoprotein B (gB) associates with MAG and mediates membrane fusion during VZV entry into host cells. The SA requirements of MAG when associating with its ligands vary depending on the specific ligand, but it is unclear whether the SAs on gB are involved in the association with MAG. In this study, we found that SAs on gB are essential for the association with MAG as well as for membrane fusion during VZV infection. MAG with a point mutation in the SA-binding site did not bind to gB and did not mediate cell-cell fusion or VZV entry. Cell-cell fusion and VZV entry mediated by the gB-MAG interaction were blocked by sialidase treatment. N-glycosylation or O-glycosylation inhibitors also inhibited the fusion and entry mediated by gB-MAG interaction. Furthermore, gB with mutations in N-glycosylation sites, i.e. asparagine residues 557 and 686, did not associate with MAG, and the cell-cell fusion efficiency was low. Fusion between the viral envelope and cellular membrane is essential for host cell entry by herpesviruses. Therefore, these results suggest that SAs on gB play important roles in MAG-mediated VZV infection. PMID:26105052

  1. Varicella-zoster virus glycoprotein expression differentially induces the unfolded protein response in infected cells.

    PubMed

    Carpenter, John E; Grose, Charles

    2014-01-01

    Varicella-zoster virus (VZV) is a human herpesvirus that spreads to children as varicella or chicken pox. The virus then establishes latency in the nervous system and re-emerges, typically decades later, as zoster or shingles. We have reported previously that VZV induces autophagy in infected cells as well as exhibiting evidence of the Unfolded Protein Response (UPR): XBP1 splicing, a greatly expanded Endoplasmic Reticulum (ER) and CHOP expression. Herein we report the results of a UPR specific PCR array that measures the levels of mRNA of 84 different components of the UPR in VZV infected cells as compared to tunicamycin treated cells as a positive control and uninfected, untreated cells as a negative control. Tunicamycin is a mixture of chemicals that inhibits N-linked glycosylation in the ER with resultant protein misfolding and the UPR. We found that VZV differentially induces the UPR when compared to tunicamycin treatment. For example, tunicamycin treatment moderately increased (8-fold) roughly half of the array elements while downregulating only three (one ERAD and two FOLD components). VZV infection on the other hand upregulated 33 components including a little described stress sensor CREB-H (64-fold) as well as ER membrane components INSIG and gp78, which modulate cholesterol synthesis while downregulating over 20 components mostly associated with ERAD and FOLD. We hypothesize that this expression pattern is associated with an expanding ER with downregulation of active degradation by ERAD and apoptosis as the cell attempts to handle abundant viral glycoprotein synthesis. PMID:25071735

  2. [Varicella zoster virus-induced meningoencephalitis complicated with orbital apex syndrome: a case report].

    PubMed

    Wakida, Kenji; Sakurai, Takeo; Nishida, Hiroshi

    2014-09-01

    A 69-year-old male was admitted to hospital with clouded consciousness and abnormal behavior. His body temperature was 38.2 degree Celsius upon admission and he was somnolent. Herpes zoster was observed along the first division of the trigeminal nerve on the right side of the face. The right palpebra was severely swollen, and the right eye showed a dilated pupil, loss of light reflex, and total ophthalmoplegia. A spinal tap revealed pleocytosis and increased proteins, and a DNA-PCR test for varicella-zoster virus (VZV) was positive. Optic neuritis was diagnosed based on fundoscopy. Following acyclovir administration, the patient regained full consciousness and the rash was alleviated; however, visual acuity did not recover. VZV-induced meningoencephalitis complicated with orbital apex syndrome is rarely observed. We suspect that VZV initially infected the nasociliary nerve at the distal end of the first division of trigeminal nerve and spread to the adjacent optic, oculomotor, trochlear, and abducens nerves, resulting in VZV-induced meningoencephalitis complicated with orbital apex syndrome. PMID:25200582

  3. Stress-induced subclinical reactivation of varicella zoster virus in astronauts

    NASA Technical Reports Server (NTRS)

    Mehta, Satish K.; Cohrs, Randall J.; Forghani, Bagher; Zerbe, Gary; Gilden, Donald H.; Pierson, Duane L.

    2004-01-01

    Varicella zoster virus (VZV) becomes latent in human ganglia after primary infection. VZV reactivation occurs primarily in elderly individuals, organ transplant recipients, and patients with cancer and AIDS, correlating with a specific decline in cell-mediated immunity to the virus. VZV can also reactivate after surgical stress. The unexpected occurrence of thoracic zoster 2 days before space flight in a 47-year-old healthy astronaut from a pool of 81 physically fit astronauts prompted our search for VZV reactivation during times of stress to determine whether VZV can also reactivate after non-surgical stress. We examined total DNA extracted from 312 saliva samples of eight astronauts before, during, and after space flight for VZV DNA by polymerase chain reaction: 112 samples were obtained 234-265 days before flight, 84 samples on days 2 through 13 of space flight, and 116 samples on days 1 through 15 after flight. Before space flight, only one of the 112 saliva samples from a single astronaut was positive for VZV DNA. In contrast, during and after space flight, 61 of 200 (30%) saliva samples were positive in all eight astronauts. No VZV DNA was detected in any of 88 saliva samples from 10 healthy control subjects. These results indicate that VZV can reactivate subclinically in healthy individuals after non-surgical stress. Copyright 2004 Wiley-Liss, Inc.

  4. Quantitative Measurement of Varicella-Zoster Virus Infection by Semiautomated Flow Cytometry▿

    PubMed Central

    Gates, Irina V.; Zhang, Yuhua; Shambaugh, Cindy; Bauman, Meredith A.; Tan, Charles; Bodmer, Jean-Luc

    2009-01-01

    Varicella-zoster virus (VZV; human herpesvirus 3) is the etiological cause of chickenpox and, upon reactivation from latency, zoster. Currently, vaccines are available to prevent both diseases effectively. A critical requirement for the manufacturing of safe and potent vaccines is the measurement of the biological activity to ensure proper dosing and efficacy, while minimizing potentially harmful secondary effects induced by immunization. In the case of live virus-containing vaccines, such as VZV-containing vaccines, biological activity is determined using an infectivity assay in a susceptible cellular host in vitro. Infectivity measurements generally rely on the enumeration of plaques by visual inspection of an infected cell monolayer. These plaque assays are generally very tedious and labor intensive and have modest throughput and high associated variability. In this study, we have developed a flow cytometry assay to measure the infectivity of the attenuated vaccine strain (vOka/Merck) of VZV in MRC-5 cells with improved throughput. The assay is performed in 96-well tissue culture microtiter plates and is based on the detection and quantification of infected cells expressing VZV glycoproteins on their surfaces. Multiple assay parameters have been investigated, including specificity, limit of detection, limit of quantification, range of linear response, signal-to-noise ratio, and precision. This novel assay appears to be in good concordance with the classical plaque assay results and therefore provides a viable, higher-throughput alternative to the plaque assay. PMID:19201967

  5. Genotyping of clinical varicella-zoster virus isolates collected from Yunnan in Southwestern China

    PubMed Central

    LI, YUNLONG; ZHU, BAOSHENG

    2016-01-01

    Varicella-zoster virus (VZV) belongs to the α-herpesvirus family. Genetically, it is stable and is divided into several genotypes based upon the genetic variations. The genotypes of VZV are rarely studied in the Southwestern region of China. In the present study, the common genetic variations in the VZV genes were examined in 42 VZV isolates collected from the patients with herpes zoster in the Yunnan province (Southwestern China). The restriction fragment length polymorphism analysis of open reading frames (ORFs) 38, 54 and 62 in the VZV genes showed that all the collected VZV isolates were PstI, BglI and SmaI positive. The R5 variable-repeat region in these isolates was variable (R5A: 46.4%; R5B: 53.6%). The sequencing data of ORFs 1, 21, 22 and 54 indicated that 41 of the 42 collected VZV isolates could be grouped into genotype J or J1. Only one VZV isolate was identified as genotype A1 or M2. No new substitutions in the sequenced fragments were found in the collected VZV isolates. The results of the present study provided a preliminary genetic characterization of the VZV strains in the Yunnan province of Southwestern China. PMID:26893840

  6. Detection of Human Herpesvirus 6 and Varicella-Zoster Virus in Tear Fluid of Patients with Bell's Palsy by PCR

    PubMed Central

    Pitkäranta, A.; Piiparinen, H.; Mannonen, L.; Vesaluoma, M.; Vaheri, A.

    2000-01-01

    Human herpesvirus 6 DNA was detected by PCR in the tear fluid of 7 (35%) of 20 patients with Bell's palsy and of 1 (5%) of 20 healthy controls. Varicella-zoster virus was detected by PCR in the tear fluid of 2 of 20 Bell's palsy patients but in none of the tear fluids from 20 healthy controls. These findings suggest an association between human herpesviruses and Bell's palsy. PMID:10878079

  7. The ORF61 Protein Encoded by Simian Varicella Virus and Varicella-Zoster Virus Inhibits NF-κB Signaling by Interfering with IκBα Degradation

    PubMed Central

    Whitmer, Travis; Malouli, Daniel; Uebelhoer, Luke S.; DeFilippis, Victor R.

    2015-01-01

    ABSTRACT Varicella-zoster virus (VZV) causes chickenpox upon primary infection and establishes latency in ganglia. Reactivation from latency causes herpes zoster, which may be complicated by postherpetic neuralgia. Innate immunity mediated by interferon and proinflammatory cytokines represents the first line of immune defense upon infection and reactivation. VZV is known to interfere with multiple innate immune signaling pathways, including the central transcription factor NF-κB. However, the role of these inhibitory mechanisms in vivo is unknown. Simian varicella virus (SVV) infection of rhesus macaques recapitulates key aspects of VZV pathogenesis, and this model thus permits examination of the role of immune evasion mechanisms in vivo. Here, we compare SVV and VZV with respect to interference with NF-κB activation. We demonstrate that both viruses prevent ubiquitination of the NF-κB inhibitor IκBα, whereas SVV additionally prevents IκBα phosphorylation. We show that the ORF61 proteins of VZV and SVV are sufficient to prevent IκBα ubiquitination upon ectopic expression. We further demonstrate that SVV ORF61 interacts with β-TrCP, a subunit of the SCF ubiquitin ligase complex that mediates the degradation of IκBα. This interaction seems to inactivate SCF-mediated protein degradation in general, since the unrelated β-TrCP target Snail is also stabilized by ORF61. In addition to ORF61, SVV seems to encode additional inhibitors of the NF-κB pathway, since SVV with ORF61 deleted still prevented IκBα phosphorylation and degradation. Taken together, our data demonstrate that SVV interferes with tumor necrosis factor alpha (TNF-α)-induced NF-κB activation at multiple levels, which is consistent with the importance of these countermechanisms for varicella virus infection. IMPORTANCE The role of innate immunity during the establishment of primary infection, latency, and reactivation by varicella-zoster virus (VZV) is incompletely understood. Since

  8. Detection of antibodies to varicella-zoster virus in recipients of the varicella vaccine by using a luciferase immunoprecipitation system assay.

    PubMed

    Cohen, Jeffrey I; Ali, Mir A; Bayat, Ahmad; Steinberg, Sharon P; Park, Hosun; Gershon, Anne A; Burbelo, Peter D

    2014-09-01

    A high-throughput test to detect varicella-zoster virus (VZV) antibodies in varicella vaccine recipients is not currently available. One of the most sensitive tests for detecting VZV antibodies after vaccination is the fluorescent antibody to membrane antigen (FAMA) test. Unfortunately, this test is labor-intensive, somewhat subjective to read, and not commercially available. Therefore, we developed a highly quantitative and high-throughput luciferase immunoprecipitation system (LIPS) assay to detect antibody to VZV glycoprotein E (gE). Tests of children who received the varicella vaccine showed that the gE LIPS assay had 90% sensitivity and 70% specificity, a viral capsid antigen enzyme-linked immunosorbent assay (ELISA) had 67% and 87% specificity, and a glycoprotein ELISA (not commercially available in the United States) had 94% sensitivity and 74% specificity compared with the FAMA test. The rates of antibody detection by the gE LIPS and glycoprotein ELISA were not statistically different. Therefore, the gE LIPS assay may be useful for detecting VZV antibodies in varicella vaccine recipients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00921999.). PMID:24990909

  9. A comparison of herpes simplex virus type 1 and varicella-zoster virus latency and reactivation

    PubMed Central

    Kennedy, Peter G. E.; Rovnak, Joel; Badani, Hussain

    2015-01-01

    Herpes simplex virus type 1 (HSV-1; human herpesvirus 1) and varicella-zoster virus (VZV; human herpesvirus 3) are human neurotropic alphaherpesviruses that cause lifelong infections in ganglia. Following primary infection and establishment of latency, HSV-1 reactivation typically results in herpes labialis (cold sores), but can occur frequently elsewhere on the body at the site of primary infection (e.g. whitlow), particularly at the genitals. Rarely, HSV-1 reactivation can cause encephalitis; however, a third of the cases of HSV-1 encephalitis are associated with HSV-1 primary infection. Primary VZV infection causes varicella (chickenpox) following which latent virus may reactivate decades later to produce herpes zoster (shingles), as well as an increasingly recognized number of subacute, acute and chronic neurological conditions. Following primary infection, both viruses establish a latent infection in neuronal cells in human peripheral ganglia. However, the detailed mechanisms of viral latency and reactivation have yet to be unravelled. In both cases latent viral DNA exists in an ‘end-less’ state where the ends of the virus genome are joined to form structures consistent with unit length episomes and concatemers, from which viral gene transcription is restricted. In latently infected ganglia, the most abundantly detected HSV-1 RNAs are the spliced products originating from the primary latency associated transcript (LAT). This primary LAT is an 8.3 kb unstable transcript from which two stable (1.5 and 2.0 kb) introns are spliced. Transcripts mapping to 12 VZV genes have been detected in human ganglia removed at autopsy; however, it is difficult to ascribe these as transcripts present during latent infection as early-stage virus reactivation may have transpired in the post-mortem time period in the ganglia. Nonetheless, low-level transcription of VZV ORF63 has been repeatedly detected in multiple ganglia removed as close to death as possible. There is

  10. Functional Characterization of the Serine-Rich Tract of Varicella-Zoster Virus IE62

    PubMed Central

    Shakya, Akhalesh K.; Kim, Seongman; O'Callaghan, Dennis J.

    2015-01-01

    ABSTRACT The immediate early 62 protein (IE62) of varicella-zoster virus (VZV), a major viral trans-activator, initiates the virus life cycle and is a key component of pathogenesis. The IE62 possesses several domains essential for trans-activation, including an acidic trans-activation domain (TAD), a serine-rich tract (SRT), and binding domains for USF, TFIIB, and TATA box binding protein (TBP). Transient-transfection assays showed that the VZV IE62 lacking the SRT trans-activated the early VZV ORF61 promoter at only 16% of the level of the full-length IE62. When the SRT of IE62 was replaced with the SRT of equine herpesvirus 1 (EHV-1) IEP, its trans-activation activity was completely restored. Herpes simplex virus 1 (HSV-1) ICP4 that lacks a TAD very weakly (1.5-fold) trans-activated the ORF61 promoter. An IE62 TAD-ICP4 chimeric protein exhibited trans-activation ability (10.2-fold), indicating that the IE62 TAD functions with the SRT of HSV-1 ICP4 to trans-activate viral promoters. When the serine and acidic residues of the SRT were replaced with Ala, Leu, and Gly, trans-activation activities of the modified IE62 proteins IE62-SRTΔSe and IE62-SRTΔAc were reduced to 46% and 29% of wild-type activity, respectively. Bimolecular complementation assays showed that the TAD of IE62, EHV-1 IEP, and HSV-1 VP16 interacted with Mediator 25 in human melanoma MeWo cells. The SRT of IE62 interacted with the nucleolar-ribosomal protein EAP, which resulted in the formation of globular structures within the nucleus. These results suggest that the SRT plays an important role in VZV viral gene expression and replication. IMPORTANCE The immediate early 62 protein (IE62) of varicella-zoster virus (VZV) is a major viral trans-activator and is essential for viral growth. Our data show that the serine-rich tract (SRT) of VZV IE62, which is well conserved within the alphaherpesviruses, is needed for trans-activation mediated by the acidic trans-activation domain (TAD). The TADs of IE62

  11. A comparison of herpes simplex virus type 1 and varicella-zoster virus latency and reactivation.

    PubMed

    Kennedy, Peter G E; Rovnak, Joel; Badani, Hussain; Cohrs, Randall J

    2015-07-01

    Herpes simplex virus type 1 (HSV-1; human herpesvirus 1) and varicella-zoster virus (VZV; human herpesvirus 3) are human neurotropic alphaherpesviruses that cause lifelong infections in ganglia. Following primary infection and establishment of latency, HSV-1 reactivation typically results in herpes labialis (cold sores), but can occur frequently elsewhere on the body at the site of primary infection (e.g. whitlow), particularly at the genitals. Rarely, HSV-1 reactivation can cause encephalitis; however, a third of the cases of HSV-1 encephalitis are associated with HSV-1 primary infection. Primary VZV infection causes varicella (chickenpox) following which latent virus may reactivate decades later to produce herpes zoster (shingles), as well as an increasingly recognized number of subacute, acute and chronic neurological conditions. Following primary infection, both viruses establish a latent infection in neuronal cells in human peripheral ganglia. However, the detailed mechanisms of viral latency and reactivation have yet to be unravelled. In both cases latent viral DNA exists in an 'end-less' state where the ends of the virus genome are joined to form structures consistent with unit length episomes and concatemers, from which viral gene transcription is restricted. In latently infected ganglia, the most abundantly detected HSV-1 RNAs are the spliced products originating from the primary latency associated transcript (LAT). This primary LAT is an 8.3 kb unstable transcript from which two stable (1.5 and 2.0 kb) introns are spliced. Transcripts mapping to 12 VZV genes have been detected in human ganglia removed at autopsy; however, it is difficult to ascribe these as transcripts present during latent infection as early-stage virus reactivation may have transpired in the post-mortem time period in the ganglia. Nonetheless, low-level transcription of VZV ORF63 has been repeatedly detected in multiple ganglia removed as close to death as possible. There is increasing

  12. Varicella-zoster immunization in pediatric liver transplant recipients: safe and immunogenic.

    PubMed

    Posfay-Barbe, K M; Pittet, L F; Sottas, C; Grillet, S; Wildhaber, B E; Rodriguez, M; Kaiser, L; Belli, D C; McLin, V A; Siegrist, C A

    2012-11-01

    Varicella can have a severe course in immunosuppressed patients. Although prevention is fundamental, live-attenuated varicella-zoster (VZV) vaccine is not currently recommended in transplant recipients. Our aims were to (1) evaluate VZV immunity in pediatric liver transplant (LT) recipients; (2) immunize (two doses) seronegative patients post-LT; (3) monitor vaccine safety, (4) assess B and T cell vaccine responses. All patients followed at the Swiss National Pediatric LT Center were approached and 77/79 (97.5%) were enrolled (median age 7.8 years). Vaccine safety was monitored by standardized diary cards and phone calls. VZV-specific serology and CD4(+) T cells were assessed before and after immunization. Thirty-nine patients (51.1%) were seronegative including 14 children immunized pre-LT. Thirty-six of 39 seronegative patients were immunized post-LT (median 3.0 years post LT). Local (54.8%) and systemic (64.5%) reactions were mild and transient. The frequency of VZV-specific CD4(+) T cells and antibody titers increased significantly (respectively from 0.085% to 0.16%, p = 0.04 and 21.0 to 1134.5 IU/L, p < 0.001). All children reached seroprotective titers and 31/32 (97%) patients assessed remained seroprotected at follow-up (median 1.7 years). No breakthrough disease was reported during follow-up (median 4.1 years). Thereby, VZV vaccine appears to be safe, immunogenic and provide protection against disease in pediatric LT patients. PMID:22994936

  13. Defensive Perimeter in the Central Nervous System: Predominance of Astrocytes and Astrogliosis during Recovery from Varicella-Zoster Virus Encephalitis

    PubMed Central

    Carpenter, John E.; Clayton, Amy C.; Halling, Kevin C.; Bonthius, Daniel J.; Buckingham, Erin M.; Jackson, Wallen; Dotzler, Steven M.; Card, J. Patrick; Enquist, Lynn W.

    2015-01-01

    ABSTRACT Varicella-zoster virus (VZV) is a highly neurotropic virus that can cause infections in both the peripheral nervous system and the central nervous system. Several studies of VZV reactivation in the peripheral nervous system (herpes zoster) have been published, while exceedingly few investigations have been carried out in a human brain. Notably, there is no animal model for VZV infection of the central nervous system. In this report, we characterized the cellular environment in the temporal lobe of a human subject who recovered from focal VZV encephalitis. The approach included not only VZV DNA/RNA analyses but also a delineation of infected cell types (neurons, microglia, oligodendrocytes, and astrocytes). The average VZV genome copy number per cell was 5. Several VZV regulatory and structural gene transcripts and products were detected. When colocalization studies were performed to determine which cell types harbored the viral proteins, the majority of infected cells were astrocytes, including aggregates of astrocytes. Evidence of syncytium formation within the aggregates included the continuity of cytoplasm positive for the VZV glycoprotein H (gH) fusion-complex protein within a cellular profile with as many as 80 distinct nuclei. As with other causes of brain injury, these results suggested that astrocytes likely formed a defensive perimeter around foci of VZV infection (astrogliosis). Because of the rarity of brain samples from living humans with VZV encephalitis, we compared our VZV results with those found in a rat encephalitis model following infection with the closely related pseudorabies virus and observed similar perimeters of gliosis. IMPORTANCE Investigations of VZV-infected human brain from living immunocompetent human subjects are exceedingly rare. Therefore, much of our knowledge of VZV neuropathogenesis is gained from studies of VZV-infected brains obtained at autopsy from immunocompromised patients. These are not optimal samples with which

  14. Single cell mass cytometry reveals remodeling of human T cell phenotypes by varicella zoster virus.

    PubMed

    Sen, Nandini; Mukherjee, Gourab; Arvin, Ann M

    2015-11-15

    The recent application of mass cytometry (CyTOF) to biology provides a 'systems' approach to monitor concurrent changes in multiple host cell factors at the single cell level. We used CyTOF to evaluate T cells infected with varicella zoster virus (VZV) infection, documenting virus-mediated phenotypic and functional changes caused by this T cell tropic human herpesvirus. Here we summarize our findings using two complementary panels of antibodies against surface and intracellular signaling proteins to elucidate the consequences of VZV-mediated perturbations on the surface and in signaling networks of infected T cells. CyTOF data was analyzed by several statistical, analytical and visualization tools including hierarchical clustering, orthogonal scaling, SPADE, viSNE, and SLIDE. Data from the mass cytometry studies demonstrated that VZV infection led to 'remodeling' of the surface architecture of T cells, promoting skin trafficking phenotypes and associated with concomitant activation of T-cell receptor and PI3-kinase pathways. This method offers a novel approach for understanding viral interactions with differentiated host cells important for pathogenesis. PMID:26213183

  15. Stress-Induced Subclinical Reactivation of Varicella Zoster Virus in Astronauts

    NASA Technical Reports Server (NTRS)

    Mehta, Satish K.; Pierson, Duane L.; Forghani, Bagher; Zerbe, Gary; Cohrs, Randall J.; Gilden, Donald H.

    2003-01-01

    After primary infection, varicella-zoster virus (VZV) becomes latent in ganglia. VZV reactivation occurs primarily in elderly individuals, organ transplant recipients, and patients with cancer and AIDS, correlating with a specific decline in cell-mediated immunity to VZV. VZV can also reactivate after surgical stress. To determine whether VZV can also reactivate after acute non-surgical stress, we examined total DNA extracted from 312 saliva samples of eight astronauts before, during and after space flight for VZV DNA by PCR: 112 samples were obtained 234 to 265 days before flight, 84 samples on days 2 through 13 of space flight, and 116 samples on days 1 through 15 after flight. Before space flight only one of the 112 saliva samples from a single astronaut was positive for VZV DNA. In contrast, during and after space flight, 61 of 200 (30%) saliva samples were positive in all 8 astronauts. No VZV DNA was detected in any of 88 saliva samples from 10 healthy control subjects. These data indicate that VZV can reactivate subclinically in healthy individuals after acute stress.

  16. Seroprevalence of varicella-zoster virus in five US-bound refugee populations.

    PubMed

    Leung, Jessica; Lopez, Adriana; Mitchell, Tarissa; Weinberg, Michelle; Lee, Deborah; Thieme, Martha; Schmid, D Scott; Bialek, Stephanie R

    2015-02-01

    Little is known about varicella-zoster virus (VZV) susceptibility in US-bound refugee populations, although published data suggest that VZV seroprevalence in these refugee populations may be lower than US populations. We describe VZV seroprevalence in five US-bound refugee groups: (1) Bhutanese in Nepal, (2) Burmese on the Thailand-Burma (Myanmar) border, (3) Burmese in Malaysia, (4) Iraqi in Jordan, and (5) Somali in Kenya. Sera were tested for presence of VZV IgG antibodies among adults aged 18-45 years. Overall VZV seroprevalence was 97% across all refugee groups. VZV seroprevalence was also high across all age groups, with seroprevalence ranging from 92-100% for 18-26 year-olds depending on refugee group and 93-100% for 27-45 year-olds. VZV seroprevalence was unexpectedly high in these five US-bound refugee groups, though may not reflect seroprevalence in other refugee groups. Additional studies are needed to better understand VZV seroprevalence in refugee populations over time and by region. PMID:24271111

  17. Molecular detection of varicella zoster virus while keeping an eye on the budget.

    PubMed

    Binkhamis, Khalifa; Al-Siyabi, Turkiya; Heinstein, Charles; Hatchette, Todd F; LeBlanc, Jason J

    2014-06-01

    Varicella zoster virus (VZV) PCR is highly sensitive compared to traditional detection methods like culture and direct fluorescent antibody testing (DFA); however, the high cost of commercial assays prohibits their use in many clinical laboratories. Major contributors to cost are the nucleic acid extraction and the PCR reagents. This study evaluated an "in-house" qualitative real-time PCR where the nucleic acid extraction was replaced by a crude extraction, homogenization and heat treatment. Three methods were compared: virus culture and DFA and real-time PCR following each extraction methods. The real-time PCR was highly specific for VZV, and the analytical sensitivity was equivalent following both extraction methods. In contrast, virus culture and DFA was approximately 10,000-fold less sensitive. Using 200 clinical specimens, the sensitivity for the real-time PCR following nucleic acid extraction or homogenization and heat treatment was essentially equivalent at 100% and 97.2%, respectively; whereas, virus culture and DFA was significantly less sensitive at 54.8%. Overall, homogenization and heat treatment combined with a qualitative in-house real-time PCR is a rapid, accurate and cost effective method for the detection of VZV. PMID:24607430

  18. Differential regulation of matrix metalloproteinases in varicella zoster virus-infected human brain vascular adventitial fibroblasts.

    PubMed

    Nagel, Maria A; Choe, Alexander; Rempel, April; Wyborny, Ann; Stenmark, Kurt; Gilden, Don

    2015-11-15

    Upon reactivation, varicella zoster virus (VZV) spreads transaxonally, infects cerebral arteries and causes ischemic or hemorrhagic stroke, as well as aneurysms. The mechanism(s) of VZV-induced aneurysm formation is unknown. However, matrix metalloproteinases (MMPs), which digest extracellular structural proteins in the artery wall, play a role in cerebral and aortic artery aneurysm formation and rupture. Here, we examined the effect of VZV infection on expression of MMP-1, -2, -3, and -9 in primary human brain vascular adventitial fibroblasts (BRAFS). At 6 days post-infection, VZV- and mock-infected BRAFs were analyzed for mRNA levels of MMP-1, -2, -3 and -9 by RT-PCR and for corresponding total intra- and extracellular protein levels by multiplex ELISA. The activity of MMP-1 was also measured in a substrate cleavage assay. Compared to mock-infected BRAFs, MMP-1, MMP-3 and MMP-9 transcripts, cell lysate protein and conditioned supernatant protein were all increased in VZV-infected BRAFs, whereas MMP-2 transcripts, cell lysate protein and conditioned supernatant protein were decreased. MMP-1 from the conditioned supernatant of VZV-infected BRAFs showed increased cleavage activity on an MMP-1-specific substrate compared to mock-infected BRAFs. Differential regulation of MMPs in VZV-infected BRAFs may contribute to aneurysm formation in VZV vasculopathy. PMID:26443282

  19. Complementary assays for monitoring susceptibility of varicella-zoster virus resistance to antivirals.

    PubMed

    Perrier, Marine; Désiré, Nathalie; Deback, Claire; Agut, Henri; Boutolleau, David; Burrel, Sonia

    2016-07-01

    The emergence of varicella-zoster virus (VZV) resistance to current antivirals as acyclovir (ACV) constitutes a hindrance to antiviral treatment effectiveness of VZV infections, especially in immunocompromised patients. The molecular mechanisms of VZV resistance reported so far rely on the presence of mutations within thymidine kinase (TK, ORF36) and DNA polymerase (ORF28) viral genes. The aim of this work was to develop reliable and complementary diagnostic methods to detect VZV antiviral resistance: (i) a genotypic assay based on TK and DNA polymerase genes sequencing, (ii) a plaque reduction assay to determine antiviral 50% effective concentrations, and (iii) a functional assay to evaluate in vitro phosphorylation activity of recombinant TKs. As a whole, this study included the analysis of 21 VZV clinical isolates and 62 biological samples from patients experiencing VZV infection. Genetic analysis revealed 3 and 9 new amino acid changes that have not been previously described within the highly conserved TK and DNA polymerase, respectively. Then, VZV isolates bearing newly identified mutations considered as natural polymorphisms were characterized as susceptible to ACV using plaque-reduction assay in MeWo cells. In parallel, the impact of TK changes on ACV phosphorylation activity was examined using a nonradioactive in vitro enzymatic assay. PMID:26994966

  20. Seroprevalence of varicella-zoster virus in five US-bound refugee populations

    PubMed Central

    Leung, Jessica; Lopez, Adriana; Mitchell, Tarissa; Weinberg, Michelle; Lee, Deborah; Thieme, Martha; Schmid, D. Scott; Bialek, Stephanie R.

    2015-01-01

    Background Little is known about varicella-zoster virus (VZV) susceptibility in US-bound refugee populations, although published data suggest that VZV seroprevalence in these refugee populations may be lower than US populations. We describe VZV seroprevalence in 5 U.S.-bound refugee groups: (1) Bhutanese in Nepal, (2) Burmese on the Thailand-Burma (Myanmar) border, (3) Burmese in Malaysia, (4) Iraqi in Jordan, and (5) Somali in Kenya. Methods Sera were tested for presence of VZV IgG antibodies among adults aged 18–45 years. Results Overall VZV seroprevalence was 97% across all refugee groups. VZV seroprevalence was also high across all age groups, with seroprevalence ranging from 92–100% for 18–26 year-olds depending on refugee group and 93–100% for 27–45 year-olds. Discussion VZV seroprevalence was unexpectedly high in these 5 US-bound refugee groups, though may not reflect seroprevalence in other refugee groups. Additional studies are needed to better understand VZV seroprevalence in refugee populations over time and by region. PMID:24271111

  1. Seroprevalence of Varicella zoster virus antibody among young women before marriage in Sanandaj, Iran

    PubMed Central

    Majidy, Parviz; Khodabandehloo, Mazaher; Azadi, Nammam-Ali

    2016-01-01

    Background and Objectives: Varicella Zoster Virus (VZV) infection in pregnant women can cause complications for the mother and fetus. The aim of this study was to assess the immunity against VZV among young women before marriage. Materials and Methods: In this cross-sectional study 250 women attending health centers in Sanandaj, Iran, for pre-marital medical check-up were randomly selected. The VZV IgG measured by ELISA and demographic characteristics of participants including their age, place of residence, number of siblings, occupation, education and history of chickenpox were also recorded. Data were analyzed using R statistical software. Association between VZV infection and participants’ characteristics was assessed using Chi-square and Fisher's exact tests. Results: Out of 250 participants, 178 individuals (71.2%) diagnosed as antibody positive and 72 (28.8%) negative. Our findings revealed that the immunity against VZV increased with individuals’ age (P<0.0001) and their number of siblings (P= 0.03). Significant association was found between history of chickenpox and immunity (P <0.001). Positive and negative predictive values of self-reported history of chickenpox obtained by 94.60% and 49.25%, respectively. Conclusion: A notable percentage of women were found to be susceptible to VZV, hence they are at risk of getting infected during pregnancy which in turn may result in fetus abnormalities. Screening the immunity and further studies on the need of vaccination before marriage are recommended. PMID:27307981

  2. A Young Woman with Ischemic Stroke: Should We Pay More Attention to Varicella Zoster Infection?

    PubMed Central

    Borbinha, Cláudia; Marto, João Pedro; Calado, Sofia; Viana-Baptista, Miguel

    2016-01-01

    Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy. PMID:27504091

  3. Pangaea and the Out-of-Africa Model of Varicella-Zoster Virus Evolution and Phylogeography

    PubMed Central

    2012-01-01

    The goal of this minireview is to provide an overview of varicella-zoster virus (VZV) phylogenetics and phylogeography when placed in the broad context of geologic time. Planet Earth was formed over 4 billion years ago, and the supercontinent Pangaea coalesced around 400 million years ago (mya). Based on detailed tree-building models, the base of the phylogenetic tree of the Herpesviridae family has been estimated at 400 mya. Subsequently, Pangaea split into Laurasia and Gondwanaland; in turn, Africa rifted from Gondwanaland. Based on available data, the hypothesis of this minireview is that the ancestral alphaherpesvirus VZV coevolved in simians, apes, and hominins in Africa. When anatomically modern humans first crossed over the Red Sea 60,000 years ago, VZV was carried along in their dorsal root ganglia. Currently, there are five VZV clades, distinguishable by single nucleotide polymorphisms. These clades likely represent continued VZV coevolution, as humans with latent VZV infection left Arabia and dispersed into Asia (clades 2 and 5) and Europe (clades 1, 3, and 4). The prototype VZV sequence contains nearly 125,000 bp, divided into 70 open reading frames. Generally, isolates within a clade display >99.9% identity to one another, while members of one clade compared to a second clade show 99.8% identity to one another. Recently, four different VZV genotypes that do not segregate into the previously defined five clades have been identified, a result indicating a wider than anticipated diversity among newly collected VZV strains around the world. PMID:22761371

  4. Bioinformatics of varicella-zoster virus: Single nucleotide polymorphisms define clades and attenuated vaccine genotypes

    PubMed Central

    Chow, Vincent T.; Tipples, Graham A.; Grose, Charles

    2012-01-01

    Varicella zoster virus (VZV) is one of the human herpesviruses. To date, over 40 complete VZV genomes have been sequenced and analyzed. The VZV genome contains around 125,000 base pairs including 70 open reading frames (ORFs). Enumeration of single nucleotide polymorphisms (SNPs) has determined that the following ORFs are the most variable (in descending order): 62, 22, 29, 28, 37, 21, 54, 31, 1 and 55. ORF 62 is the major immediate early regulatory VZV gene. Further SNP analysis across the entire genome has led to the observation that VZV strains can be broadly grouped into clades within a phylogenetic tree. VZV strains collected in Singapore provided important sequence data for construction of the phylogenetic tree. Currently 5 VZV clades are recognized; they have been designated clades 1 through 5. Clades 1 and 3 include European/North American strains; clade 2 includes Asian strains, especially from Japan; and clade 5 includes strains from India. Clade 4 includes some strains from Europe, but its geographic origins need further documentation.. Within clade 1, five variant viruses have been isolated with a missense mutation in the gE (ORF 68) glycoprotein; these strains have an altered increased cell spread phenotype. Bioinformatics analyses of the attenuated vaccine strains have also been performed, with a subsequent discovery of a stop-codon SNP in ORFO as a likely attenuation determinant. Taken together, these VZV bioinformatics analyses have provided enormous insights into VZV phylogenetics as well as VZV SNPs associated with attenuation. PMID:23183312

  5. Novel approach to differentiate subclades of varicella-zoster virus genotypes E1 and E2 in Germany.

    PubMed

    Schmidt-Chanasit, Jonas; Olschläger, Stephan; Bialonski, Alexandra; Heinemann, Patrick; Bleymehl, Karoline; Gross, Gerd; Günther, Stephan; Ulrich, Rainer G; Doerr, Hans Wilhelm

    2009-11-01

    Varicella-zoster virus (VZV) is the causative agent of chicken pox (varicella) in children and reactivation of VZV in elderly or immunocompromised persons can cause shingles (zoster). A subclade differentiation of the most prevalent VZV genotypes E1 and E2 in Germany was not possible with the current genotyping methods in use, but is highly important to understand the VZV molecular evolution in more detail and especially to follow up the routes of infection. Therefore the objective of this study was to develop a simple PCR-based method for differentiation of E1 and E2 subclades. Viral DNA was isolated from vesicle fluid samples of six selected German zoster patients and used to amplify nine complete open reading frames (ORFs) of the VZV genome by different PCR assays. Phylogenetic analysis was performed by a Bayesian approach. Based on the analysis of a total of nine ORFs, a 7482 bp stretch consisting of ORFs 5, 37 and 62 contained informative sites for identification of novel subclades E1a, E2a and E2b for VZV genotypes E1 and E2. Specific single nucleotide polymorphisms (SNPs) were demonstrated for subclades E2a and E2b within the ORFs 5, 37 and 62, whereas a subclade E1a-specific SNP was found in ORF 56. The classification of E1 and E2 subclades may facilitate a more exact and in-depth monitoring of the molecular evolution of VZV in Germany in the future. PMID:19712712

  6. Long Term Persistence of IgE Anti-Varicella Zoster Virus in Pediatric and Adult Serum Post Chicken Pox Infection and after Vaccination with Varicella Virus Vaccine.

    PubMed

    Smith-Norowitz, Tamar A; Josekutty, Joby; Silverberg, Jonathan I; Lev-Tov, Hadar; Norowitz, Yitzchok M; Kohlhoff, Stephan; Nowakowski, Maja; Durkin, Helen G; Bluth, Martin H

    2009-12-01

    The production of IgE specific to different viruses (HIV-1, Parvovirus B19, RSV), and the ability for IgE anti-HIV-1 to suppress HIV-1 production in vitro, strongly suggest an important role for IgE and/or anti viral specific IgE in viral pathogenesis. Previous studies in our laboratory were the first to report the presence of IgE anti-varicella zoster virus (VZV) in an adolescent patient with shingles. However, the presence and long term persistence of IgE anti VZV antibodies has not been studied in adults. The presence of serum IgE in addition to IgE and IgG anti-VZV antibody in sera were studied in children (N=12) (0-16 y/o) and adults (N=9) (32-76 y/o) with either a past history of (wild type) chicken pox (N=7 children, 9 adults) or 5 years after vaccination with varicella zoster (N=2 children) (Varicella virus vaccine live, Oka/Merck), as well as in non-infected subjects (N=3 children). Of the patients who had a positive history of chicken pox 13 of 16 (81%) contained IgE anti-VZV antibodies; they were both serum IgEHi (>100 IU/ml) and IgELo (<100 IU/ml). Of the patients who were vaccinated, IgE anti-VZV antibodies were undetected. In contrast, serum from the patients without a history of chicken pox or vaccination did not make either IgE or IgG anti-VZV antibodies. This is the first demonstration of the existence of IgE anti-VZV antibodies, and its long-term persistence in serum of previously infected subjects. Future studies regarding the functional role of anti-viral IgE and its relationship to VZV are warranted. PMID:23675158

  7. Nodular Scleritis Associated with Herpes Zoster Virus: An Infectious and Immune-Mediated Process.

    PubMed

    Loureiro, Mónica; Rothwell, Renata; Fonseca, Sofia

    2016-01-01

    Purpose. To describe a case of anterior nodular scleritis, preceded by an anterior hypertensive uveitis, which was primarily caused by varicella zoster virus (VZV). Case Report. A 54-year-old woman presented with anterior uveitis of the right eye presumably caused by herpetic viral disease and was successfully treated. Two months later, she developed a nodular scleritis and started oral nonsteroidal anti-inflammatory without effect. A complete laboratory workup revealed positivity for HLA-B27; the infectious workup was negative. Therapy was changed to oral prednisolone and an incomplete improvement occurred. Therefore, a diagnostic anterior paracentesis was performed and the polymerase chain reaction (PCR) analysis revealed VZV. She was treated with valacyclovir and the oral prednisolone began to decrease; however, a marked worsening of the scleritis occurred with the reduction of the daily dose; subsequently, methotrexate was introduced allowing the suspension of the prednisolone and led to clinical resolution of the scleritis. Conclusion. This report of anterior nodular scleritis caused by VZV argues in favor of an underlying immune-mediated component, requiring immunosuppressive therapy for clinical resolution. The PCR analysis of the aqueous humor was revealed to be a valuable technique and should be considered in cases of scleritis with poor response to treatment. PMID:27298747

  8. Nodular Scleritis Associated with Herpes Zoster Virus: An Infectious and Immune-Mediated Process

    PubMed Central

    Loureiro, Mónica; Rothwell, Renata; Fonseca, Sofia

    2016-01-01

    Purpose. To describe a case of anterior nodular scleritis, preceded by an anterior hypertensive uveitis, which was primarily caused by varicella zoster virus (VZV). Case Report. A 54-year-old woman presented with anterior uveitis of the right eye presumably caused by herpetic viral disease and was successfully treated. Two months later, she developed a nodular scleritis and started oral nonsteroidal anti-inflammatory without effect. A complete laboratory workup revealed positivity for HLA-B27; the infectious workup was negative. Therapy was changed to oral prednisolone and an incomplete improvement occurred. Therefore, a diagnostic anterior paracentesis was performed and the polymerase chain reaction (PCR) analysis revealed VZV. She was treated with valacyclovir and the oral prednisolone began to decrease; however, a marked worsening of the scleritis occurred with the reduction of the daily dose; subsequently, methotrexate was introduced allowing the suspension of the prednisolone and led to clinical resolution of the scleritis. Conclusion. This report of anterior nodular scleritis caused by VZV argues in favor of an underlying immune-mediated component, requiring immunosuppressive therapy for clinical resolution. The PCR analysis of the aqueous humor was revealed to be a valuable technique and should be considered in cases of scleritis with poor response to treatment. PMID:27298747

  9. Construction of Recombinant Mouse IgG1 Antibody Directed Against Varicella Zoster Virus Immediate Early Protein 63

    PubMed Central

    MUELLER, NIKLAUS H.; GRAF, LAURIE L.; SHEARER, ANDREW J.; OWENS, GREGORY P.; GILDEN, DONALD H.; COHRS, RANDALL J.

    2010-01-01

    Five varicella zoster virus (VZV) genes are known to be transcribed in latently infected human ganglia. Transcripts from VZV gene 63, which encodes an immediate early (IE) protein, are the most prevalent and abundant. To obtain a reagent that might facilitate studies of the role of the IE63 protein in latency and reactivation, we selected an IE63-specific Fab fragment from a phage library and used it to prepare a recombinant mouse IgG1 antibody that detects IE63 and functions in Western blot, immunoprecipitation, enzyme-linked immunosorbent assay (ELISA), and immunofluorescence assays. PMID:18294070

  10. Use of oral fluid to examine the molecular epidemiology of varicella zoster virus in the United Kingdom and continental Europe.

    PubMed

    Quinlivan, Mark; Sengupta, Nitu; Papaevangelou, Vassiliki; Sauerbrei, Andreas; Grillner, Lena; Rousseva, Rossitsa; Hague, Rosie; Lutsar, Irja; Jogi, Piia; Leca, Ana; Grytchol, Ruth; Alain, Sophie; Breuer, Judith

    2013-02-15

    We investigated oral fluid (OF) as an alternative to sampling of rashes for varicella zoster virus (VZV) genotyping and further characterized VZV clade prevalence in the United Kingdom and Europe. VZV was detected in up to 91% of OF specimens. Paired OF and vesicle fluid samples contained identical VZV clades. While clades 1 and 3 were the most prevalent across the United Kingdom and Europe, in Western Europe, clade 5 viruses were circulating. Viruses from the same outbreak belonged to different clades, but no clade was associated with a severe-disease phenotype. OF is suitable and convenient for large-scale molecular epidemiological studies of VZV. PMID:23087434

  11. Differentiation of strains of varicella-zoster virus by changes in neutral lipid metabolism in infected cells

    SciTech Connect

    Jerkofsky, M.; De Siervo, A.J.

    1986-03-01

    Eleven isolates of varicella-zoster virus were tested for their effects on the incorporation of (/sup 14/C)acetate into lipids in infected human embryonic lung cells. By relative percent, all virus isolates demonstrated a shift from polar lipid synthesis to neutral lipid, especially triglyceride, synthesis. By data expressed as counts per minute per microgram of protein, the VZV strains could be separated into two groups: those strains which depressed lipid synthesis and those strains which did not depress, and may even have stimulated, lipid, especially triglyceride, synthesis. These results may be useful in understanding the development of lipid changes seen in children affected with Reye's syndrome following chickenpox.

  12. B-cell repertoire responses to varicella-zoster vaccination in human identical twins.

    PubMed

    Wang, Chen; Liu, Yi; Cavanagh, Mary M; Le Saux, Sabine; Qi, Qian; Roskin, Krishna M; Looney, Timothy J; Lee, Ji-Yeun; Dixit, Vaishali; Dekker, Cornelia L; Swan, Gary E; Goronzy, Jörg J; Boyd, Scott D

    2015-01-13

    Adaptive immune responses in humans rely on somatic genetic rearrangements of Ig and T-cell receptor loci to generate diverse antigen receptors. It is unclear to what extent an individual's genetic background affects the characteristics of the antibody repertoire used in responding to vaccination or infection. We studied the B-cell repertoires and clonal expansions in response to attenuated varicella-zoster vaccination in four pairs of adult identical twins and found that the global antibody repertoires of twin pair members showed high similarity in antibody heavy chain V, D, and J gene segment use, and in the length and features of the complementarity-determining region 3, a major determinant of antigen binding. These twin similarities were most pronounced in the IgM-expressing B-cell pools, but were seen to a lesser extent in IgG-expressing B cells. In addition, the degree of antibody somatic mutation accumulated in the B-cell repertoire was highly correlated within twin pair members. Twin pair members had greater numbers of shared convergent antibody sequences, including mutated sequences, suggesting similarity among memory B-cell clonal lineages. Despite these similarities in the memory repertoire, the B-cell clones used in acute responses to ZOSTAVAX vaccination were largely unique to each individual. Taken together, these results suggest that the overall B-cell repertoire is significantly shaped by the underlying germ-line genome, but that stochastic or individual-specific effects dominate the selection of clones in response to an acute antigenic stimulus. PMID:25535378

  13. Glycoprotein E of Varicella-Zoster Virus Enhances Cell-Cell Contact in Polarized Epithelial Cells

    PubMed Central

    Mo, Chengjun; Schneeberger, Eveline E.; Arvin, Ann M.

    2000-01-01

    Varicella-zoster virus (VZV) infection involves the cell-cell spread of virions, but how viral proteins interact with the host cell membranes that comprise intercellular junctions is not known. Madin-Darby canine kidney (MDCK) cells were constructed to express the glycoproteins gE, gI, or gE/gI constitutively and were used to examine the effects of these VZV glycoproteins in polarized epithelial cells. At low cell density, VZV gE induced partial tight junction (TJ) formation under low-calcium conditions, whether expressed alone or with gI. Although most VZV gE was intracellular, gE was also shown to colocalize with the TJ protein ZO-1 with or without concomitant expression of gI. Freeze fracture electron microscopy revealed normal TJ strand morphology in gE-expressing MDCK cells. Functionally, the expression of gE was associated with a marked acceleration in the establishment of maximum transepithelial electrical resistance (TER) in MDCK-gE cells; MDCK-gI and MDCK-gE/gI cells exhibited a similar pattern of early TER compared to MDCK cells, although peak resistances were lower than those of gE alone. VZV gE expression altered F-actin organization and lipid distribution, but coexpression of gI modulated these effects. Two regions of the gE ectodomain, amino acids (aa) 278 to 355 and aa 467 to 498, although lacking Ca2+ binding motifs, exhibit similarities with corresponding regions of the cell adhesion molecules, E-cadherin and desmocollin. These observations suggest that VZV gE and gE/gI may contribute to viral pathogenesis by facilitating epithelial cell-cell contacts. PMID:11070038

  14. Novel polyvalent live vaccine against varicella-zoster and mumps virus infections.

    PubMed

    Matsuura, Masaaki; Somboonthum, Pranee; Murakami, Kouki; Ota, Megumi; Shoji, Masaki; Kawabata, Kenji; Mizuguchi, Hiroyuki; Gomi, Yasuyuki; Yamanishi, Koichi; Mori, Yasuko

    2013-10-01

    The varicella-zoster virus (VZV) Oka vaccine strain (vOka) is a highly immunogenic and safe live vaccine that has long been used worldwide. Because its genome is large, making it suitable for inserting foreign genes, vOka is considered a candidate vector for novel polyvalent vaccines. Previously, a recombinant vOka, rvOka-HN, that expresses mumps virus (MuV) hemagglutinin-neuraminidase (HN) was generated by the present team. rvOka-HN induces production of neutralizing antibodies against MuV in guinea pigs. MuV also expresses fusion (F) protein, which is important for inducing neutralizing antibodies, in its viral envelope. To induce a more robust immune response against MuV than that obtained with rvOka-HN, here an rvOka expressing both HN and F (rvOka-HN-F) was generated. However, co-expression of HN and F caused the infected cells to form syncytia, which reduced virus titers. To reduce the amount of cell fusion, an rvOka expressing HN and a mutant F, F(S195Y) were generated. Almost no syncytia formed among the rvOka-HN-F(S195Y)-infected cells and the growth of rvOka-HN-F(S195Y) was similar to that of the original vOka clone. Moreover, replacement of serine 195 with tyrosine had no effect on the immunogenicity of F in mice and guinea pigs. Although obvious augmentation of neutralizing antibody production was not observed after adding F protein to vOka-HN, the anti-F antibodies did have neutralizing activity. These data suggest that F protein contributes to induction of immune protection against MuV. Therefore this recombinant virus is a promising candidate vaccine for polyvalent protection against both VZV and MuV. PMID:23905963

  15. Impact of Varicella-Zoster Virus on Dendritic Cell Subsets in Human Skin during Natural Infection▿ †

    PubMed Central

    Huch, Jennifer H.; Cunningham, Anthony L.; Arvin, Ann M.; Nasr, Najla; Santegoets, Saskia J. A. M.; Slobedman, Eric; Slobedman, Barry; Abendroth, Allison

    2010-01-01

    Varicella-zoster virus (VZV) causes varicella and herpes zoster, diseases characterized by distinct cutaneous rashes. Dendritic cells (DC) are essential for inducing antiviral immune responses; however, the contribution of DC subsets to immune control during natural cutaneous VZV infection has not been investigated. Immunostaining showed that compared to normal skin, the proportion of cells expressing DC-SIGN (a dermal DC marker) or DC-LAMP and CD83 (mature DC markers) were not significantly altered in infected skin. In contrast, the frequency of Langerhans cells was significantly decreased in VZV-infected skin, whereas there was an influx of plasmacytoid DC, a potent secretor of type I interferon (IFN). Langerhans cells and plasmacytoid DC in infected skin were closely associated with VZV antigen-positive cells, and some Langerhans cells and plasmacytoid DC were VZV antigen positive. To extend these in vivo observations, both plasmacytoid DC (PDC) isolated from human blood and Langerhans cells derived from MUTZ-3 cells were shown to be permissive to VZV infection. In VZV-infected PDC cultures, significant induction of alpha IFN (IFN-α) did not occur, indicating the VZV inhibits the capacity of PDC to induce expression of this host defense cytokine. This study defines changes in the response of DC which occur during cutaneous VZV infection and implicates infection of DC subtypes in VZV pathogenesis. PMID:20130046

  16. Serological Evaluation of Immunity to the Varicella-Zoster Virus Based on a Novel Competitive Enzyme-Linked Immunosorbent Assay

    PubMed Central

    Liu, Jian; Ye, Xiangzhong; Jia, Jizong; Zhu, Rui; Wang, Lina; Chen, Chunye; Yang, Lianwei; Wang, Yongmei; Wang, Wei; Ye, Jianghui; Li, Yimin; Zhu, Hua; Zhao, Qinjian; Cheng, Tong; Xia, Ningshao

    2016-01-01

    Varicella-zoster virus (VZV) is a highly contagious agent of varicella and herpes zoster. Varicella can be lethal to immunocompromised patients, babies, HIV patients and other adults with impaired immunity. Serological evaluation of immunity to VZV will help determine which individuals are susceptible and evaluate vaccine effectiveness. A collection of 110 monoclonal antibodies (mAbs) were obtained by immunization of mice with membrane proteins or cell-free virus. The mAbs were well characterized, and a competitive sandwich ELISA (capture mAb: 8H6; labelling mAb: 1B11) was established to determine neutralizing antibodies in human serum with reference to the FAMA test. A total of 920 human sera were evaluated. The competitive sandwich ELISA showed a sensitivity of 95.6%, specificity of 99.77% and coincidence of 97.61% compared with the fluorescent-antibody-to-membrane-antigen (FAMA) test. The capture mAb 8H6 was characterized as a specific mAb for VZV ORF9, a membrane-associated tegument protein that interacts with glycoprotein E (gE), glycoprotein B (gB) and glycoprotein C (gC). The labelling mAb 1B11 was characterized as a complement-dependent neutralizing mAb specific for the immune-dominant epitope located on gE, not on other VZV glycoproteins. The established competitive sandwich ELISA could be used as a rapid and high-throughput method for evaluating immunity to VZV. PMID:26853741

  17. Identification of immunodominant regions and linear B cell epitopes of the gE envelope protein of varicella-zoster virus.

    PubMed

    Fowler, W J; Garcia-Valcarcel, M; Hill-Perkins, M S; Murphy, G; Harper, D R; Jeffries, D J; Burns, N R; Adams, S E; Kingsman, A J; Layton, G T

    1995-12-20

    The envelope proteins of varicella-zoster virus (VZV) are highly immunogenic and one of the most abundant is glycoprotein E (gE). However, its immunodominant regions and epitopes have not been identified. In this study, using human sera from individuals with recent varicella or zoster infections, we have localized antigenic sequences of gE using recombinant hybrid Ty-virus-like particles (VLPs) carrying overlapping fragments of the gE protein. gE(1-134)-VLPs (particles carrying amino acids 1-134 of gE) and, to a lesser extent, gE(101-161)-VLPs were found to be the most antigenic when tested by Western blotting and ELISA. Other fragments of gE (spanning residues 161-623) showed weak or no antigenicity. Pepscan analysis of human sera on overlapping synthetic peptides representing residues 1-135 of gE revealed that the most antigenic region was between residues 50 and 135. Three immunodominant sequences (residues 86-105, 116-135, and, to a lesser extent, 56-75) were detected using sera from both varicella and zoster patients. All sera from varicella, but not zoster, patients reacted strongly with an epitope in peptide 66-85. Other epitopes were recognized weakly by some varicella or zoster sera. More sera need to be tested to assess the potential disease specificity of these epitopes. The neutralizing monoclonal antibody (MAb) IF-B9 reacted with residues 71-90; however, another neutralizing MAb, SG1A, which bound to both gE(1-134)-VLPs and gE(101-161)-VLPs did not bind to any peptide. The identification of immunodominant sequences of gE will help toward the development of a subunit VZV vaccine. PMID:8553555

  18. Chickenpox (Varicella) Photos

    MedlinePlus

    ... advised. Click on any image to enlarge it. Images of People Affected by the Disease Chickenpox in ... vaccinated child. Courtesy of Varicella Active Surveillance Project Images of Varicella Zoster Virus PHIL Photo ID# 2791 ...

  19. [Seroprevalence of rubella virus, varicella zoster virus, cytomegalovirus and parvovirus B19 among pregnant women in the Sousse region, Tunisia].

    PubMed

    Hannachi, N; Marzouk, M; Harrabi, I; Ferjani, A; Ksouri, Z; Ghannem, H; Khairi, H; Hidar, S; Boukadida, J

    2011-02-01

    The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (> 2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women. PMID:21243459

  20. Incidence and risk of postherpetic neuralgia after varicella zoster virus infection in hematopoietic cell transplantation recipients: Hokkaido Hematology Study Group.

    PubMed

    Onozawa, Masahiro; Hashino, Satoshi; Haseyama, Yoshifumi; Hirayama, Yasuo; Iizuka, Susumu; Ishida, Tadao; Kaneda, Makoto; Kobayashi, Hajime; Kobayashi, Ryoji; Koda, Kyuhei; Kurosawa, Mitsutoshi; Masauji, Nobuo; Matsunaga, Takuya; Mori, Akio; Mukai, Masaya; Nishio, Mitsufumi; Noto, Satoshi; Ota, Shuichi; Sakai, Hajime; Suzuki, Nobuhiro; Takahashi, Tohru; Tanaka, Junji; Torimoto, Yoshihiro; Yoshida, Makoto; Fukuhara, Takashi

    2009-06-01

    To assess the incidence of and risk factors associated with postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT) varicella zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. The male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = .0075; odds ratio [OR] = 1.14; 95% confidence interval [CI], 0.97-1.33). On the other hand, advanced age (P = .0097; OR = 1.06; 95% CI, 1.01-1.12), male gender (P = .0055; OR = 12.7; 95% CI, 1.61-100.1), and graft-versus-host disease (GVHD) prophylaxis with a tacrolimus-based regimen (P = .0092; OR = 9.56; 95% CI, 1.44-63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients. PMID:19450757

  1. Varicella-Zoster Virus Open Reading Frame 66 Protein Kinase and Its Relationship to Alphaherpesvirus US3 Kinases

    PubMed Central

    Erazo, Angela

    2014-01-01

    The varicella-zoster virus (VZV) open reading frame (ORF) 66 encodes a basophilic kinase orthologous to the US3 protein kinases found in all alphaherpesviruses. This review summarizes current information on the ORF66 kinase, and outlines apparent differences from other US3 kinases, as well as some of the conserved functions. One critical difference is the VZV ORF66 kinase targeting of the major regulatory VZV IE62 protein to control its nuclear import and assembly into the VZV virion, which is so far unprecedented in the alphaherpesviruses. However, ORF66 targets some cellular targets which are also targeted by US3 kinases of other herpesviruses, including the histone deacetylase-1 and 2 proteins, pathways that lead to changes in actin dynamics, and the targeting of substrates of protein kinase A, including the nuclear matrix protein matrin 3. PMID:20186610

  2. Primary cutaneous precursor B cell lymphoblastic lymphoma in a child, complicated by fatal disseminated varicella zoster virus.

    PubMed

    Rashidghamat, E; Robson, A

    2015-12-01

    Precursor B-cell lymphoblastic lymphoma (PBLL) is a rare subtype of childhood non-Hodgkin lymphoma (NHL). Most lymphoblastic lymphomas have a T-cell immunophenotype, but a small distinct proportion is of precursor B-cell origin. Skin and bone involvement is seen more commonly in this clinical variant. Primary cutaneous PBLL is rare. We describe an 8-year-old girl who presented with an asymptomatic nodule on the left upper arm. Histopathological features were consistent with pre-B-cell lymphoblastic lymphoma, and staging investigations excluded extracutaneous disease, resulting in a diagnosis of primary cutaneous PBLL. The child was started on induction chemotherapy, UKALL 2003 regimen B. She developed disseminated varicella zoster virus and died despite treatment. We discuss previously reported cases of primary cutaneous PBLL and their outcomes. PMID:25959984

  3. Suppressor of Cytokine Signaling 3 Expression Induced by Varicella-Zoster Virus Infection Results in the Modulation of Virus Replication.

    PubMed

    Choi, E-J; Lee, C-H; Shin, O S

    2015-10-01

    Varicella-zoster virus (VZV) is an important viral pathogen that is responsible for causing varicella (chickenpox) and herpes zoster (shingles). VZV has been shown to suppress early anti-viral innate immune responses, but the exact mechanisms are not yet well understood. Here we demonstrate that host control of VZV is impaired by the expression of suppressor of cytokine signaling (SOCS)3. We used three different cell types to characterize VZV-induced anti-viral and inflammatory responses. Infection of human fibroblasts (MRC-5) and human macrophages (THP-1) with VZV triggered upregulation of anti-viral responsive gene expression (IFN-α, IFN-β) in the early phases of infection, followed by the waning of these IFNs in the late phases of infection. Conversely, VZV infection in keratinocytes (HaCaT) resulted in a persistent increase in type I IFN gene expression. Interestingly, increase in SOCS1 and 3 expressions coincided with a reduction in phosphorylation of the signal transducer and activator of transcription protein 3 (STAT3) in VZV-infected MRC-5 cells. Furthermore, VZV infection increased the production of pro-inflammatory cytokines, including interleukin (IL)-6, -8, and IFN-γ-inducible protein 10 (IP-10). Knockdown of SOCS3 inhibited viral replication and enhanced secretion levels of IL-6, whereas overexpression of SOCS3 did not affect viral replication efficiency and host response. In conclusion, our data suggest that VZV infection induces SOCS3 expression, resulting in modulation of type I IFN signaling and viral replication. PMID:26072679

  4. Global Mapping of O-Glycosylation of Varicella Zoster Virus, Human Cytomegalovirus, and Epstein-Barr Virus.

    PubMed

    Bagdonaite, Ieva; Nordén, Rickard; Joshi, Hiren J; King, Sarah L; Vakhrushev, Sergey Y; Olofsson, Sigvard; Wandall, Hans H

    2016-06-01

    Herpesviruses are among the most complex and widespread viruses, infection and propagation of which depend on envelope proteins. These proteins serve as mediators of cell entry as well as modulators of the immune response and are attractive vaccine targets. Although envelope proteins are known to carry glycans, little is known about the distribution, nature, and functions of these modifications. This is particularly true for O-glycans; thus we have recently developed a "bottom up" mass spectrometry-based technique for mapping O-glycosylation sites on herpes simplex virus type 1. We found wide distribution of O-glycans on herpes simplex virus type 1 glycoproteins and demonstrated that elongated O-glycans were essential for the propagation of the virus. Here, we applied our proteome-wide discovery platform for mapping O-glycosites on representative and clinically significant members of the herpesvirus family: varicella zoster virus, human cytomegalovirus, and Epstein-Barr virus. We identified a large number of O-glycosites distributed on most envelope proteins in all viruses and further demonstrated conserved patterns of O-glycans on distinct homologous proteins. Because glycosylation is highly dependent on the host cell, we tested varicella zoster virus-infected cell lysates and clinically isolated virus and found evidence of consistent O-glycosites. These results present a comprehensive view of herpesvirus O-glycosylation and point to the widespread occurrence of O-glycans in regions of envelope proteins important for virus entry, formation, and recognition by the host immune system. This knowledge enables dissection of specific functional roles of individual glycosites and, moreover, provides a framework for design of glycoprotein vaccines with representative glycosylation. PMID:27129252

  5. Autophagosome Formation during Varicella-Zoster Virus Infection following Endoplasmic Reticulum Stress and the Unfolded Protein Response ▿ † ‡

    PubMed Central

    Carpenter, John E.; Jackson, Wallen; Benetti, Luca; Grose, Charles

    2011-01-01

    Autophagy is a recently recognized component of the life cycle of varicella-zoster virus (VZV). We have documented abundant autophagosome formation in skin vesicles (final site of virion assembly) from randomly selected cases of varicella and zoster. The fact that autophagy was an early event in the VZV replication cycle was documented by finding infected vesicle cells with the VZV IE62 protein confined to the nucleus. Next, we pursued studies in VZV-infected cultured cells to define whether autophagy was preceded by endoplasmic reticulum (ER) stress and the unfolded protein response (UPR). First, we demonstrated that autophagosome formation in infected cells closely resembled that seen after treatment of cells with tunicamycin, a potent initiator of ER stress. Second, we demonstrated a marked expansion of ER size in both VZV-infected cells and cells transfected with the predominant VZV glycoprotein complex gE/gI. An enlarged ER is critical evidence of ER stress, which in turn is relieved by the UPR. To this end, we documented the UPR by detecting the alternatively spliced form of the XBP1 protein as well as CHOP (C/EBP homologous protein), both transcriptional activators of other UPR genes in an ER stress-dependent manner. Because VZV does not encode inhibitors of autophagy, the above results suggested that autophagy was a common event in VZV-infected cells and that it was provoked at least in part by ER stress secondary to overly abundant VZV glycoprotein biosynthesis, which led to UPR activation in an attempt to maintain cellular homeostasis. PMID:21752906

  6. Seroprevalence and Risk Factors of Varicella Zoster Infection in Iranian Adolescents: A Multilevel Analysis; The CASPIAN-III Study

    PubMed Central

    Hoseini, Shervin Ghaffari; Kelishadi, Roya; Kasaeian, Amir; Ataei, Behrooz; Yaran, Majid; Motlagh, Mohammad Esmaeil; Heshmat, Ramin; Ardalan, Gelayol; Safari, Omid

    2016-01-01

    The objective of this study was to evaluate the varicella zoster virus (VZV) immunity in Iranian adolescents. It was conducted as a primary study for vaccine implementation, and to investigate the association of climatic and socioeconomic factors with the epidemiology of this infection. In this cross- sectional study, anti VZV antibodies were measured in serum samples obtained in a national school-based health survey (CASPIAN- III). Association of demographic, socio-economic, and climate of the living region with the frequency of VZV was investigated by multivariate multilevel analysis. Overall, sera of 2753 individuals aged 10–18 were tested for VZV antibodies, from those 87.4% were positive. The prevalence was statistically different in four socio-geographic regions (P<0.001), varying between 85.24% in West region (mostly mountainous areas with cold climate) to 94.59% in Southeast region (subtropical climate). Among variables studied, only age and mean daily temperature of the living area were positively associated with the VZV seroprevalence. Our findings show that most Iranians develop immunity to VZV before the age of 10, but a substantial proportion of them are yet susceptible to the infection. Therefore, it seems that the best strategy to reduce the burden of the disease is to vaccinate high- risk adults, i.e. those without a history of varicella infection. The regional temperature might be the only determinant of VZV epidemiology in Iran. PMID:27355931

  7. Seroprevalence and Risk Factors of Varicella Zoster Infection in Iranian Adolescents: A Multilevel Analysis; The CASPIAN-III Study.

    PubMed

    Hoseini, Shervin Ghaffari; Kelishadi, Roya; Kasaeian, Amir; Ataei, Behrooz; Yaran, Majid; Motlagh, Mohammad Esmaeil; Heshmat, Ramin; Ardalan, Gelayol; Safari, Omid; Qorbani, Mostafa; Mostafavi, Seyed Naseredin

    2016-01-01

    The objective of this study was to evaluate the varicella zoster virus (VZV) immunity in Iranian adolescents. It was conducted as a primary study for vaccine implementation, and to investigate the association of climatic and socioeconomic factors with the epidemiology of this infection. In this cross- sectional study, anti VZV antibodies were measured in serum samples obtained in a national school-based health survey (CASPIAN- III). Association of demographic, socio-economic, and climate of the living region with the frequency of VZV was investigated by multivariate multilevel analysis. Overall, sera of 2753 individuals aged 10-18 were tested for VZV antibodies, from those 87.4% were positive. The prevalence was statistically different in four socio-geographic regions (P<0.001), varying between 85.24% in West region (mostly mountainous areas with cold climate) to 94.59% in Southeast region (subtropical climate). Among variables studied, only age and mean daily temperature of the living area were positively associated with the VZV seroprevalence. Our findings show that most Iranians develop immunity to VZV before the age of 10, but a substantial proportion of them are yet susceptible to the infection. Therefore, it seems that the best strategy to reduce the burden of the disease is to vaccinate high- risk adults, i.e. those without a history of varicella infection. The regional temperature might be the only determinant of VZV epidemiology in Iran. PMID:27355931

  8. Herpes Zoster.

    PubMed

    Schmader, Kenneth

    2016-08-01

    Herpes zoster causes significant suffering owing to acute and chronic pain or postherpetic neuralgia (PHN). Varicella-zoster virus-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities of daily living, and reduced quality of life in older adults. The optimal treatment of herpes zoster requires early antiviral therapy and careful pain management. For patients who have PHN, evidence-based pharmacotherapy using topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, or opiates can reduce pain burden. The live attenuated zoster vaccine is effective in reducing pain burden and preventing herpes zoster and PHN in older adults. PMID:27394022

  9. The Varicella-Zoster Virus Portal Protein Is Essential for Cleavage and Packaging of Viral DNA

    PubMed Central

    Visalli, Melissa A.; House, Brittany L.; Selariu, Anca; Zhu, Hua

    2014-01-01

    ABSTRACT The varicella-zoster virus (VZV) open reading frame 54 (ORF54) gene encodes an 87-kDa monomer that oligomerizes to form the VZV portal protein, pORF54. pORF54 was hypothesized to perform a function similar to that of a previously described herpes simplex virus 1 (HSV-1) homolog, pUL6. pUL6 and the associated viral terminase are required for processing of concatemeric viral DNA and packaging of individual viral genomes into preformed capsids. In this report, we describe two VZV bacterial artificial chromosome (BAC) constructs with ORF54 gene deletions, Δ54L (full ORF deletion) and Δ54S (partial internal deletion). The full deletion of ORF54 likely disrupted essential adjacent genes (ORF53 and ORF55) and therefore could not be complemented on an ORF54-expressing cell line (ARPE54). In contrast, Δ54S was successfully propagated in ARPE54 cells but failed to replicate in parental, noncomplementing ARPE19 cells. Transmission electron microscopy confirmed the presence of only empty VZV capsids in Δ54S-infected ARPE19 cell nuclei. Similar to the HSV-1 genome, the VZV genome is composed of a unique long region (UL) and a unique short region (US) flanked by inverted repeats. DNA from cells infected with parental VZV (VZVLUC strain) contained the predicted UL and US termini, whereas cells infected with Δ54S contained neither. This result demonstrates that Δ54S is not able to process and package viral DNA, thus making pORF54 an excellent chemotherapeutic target. In addition, the utility of BAC constructs Δ54L and Δ54S as tools for the isolation of site-directed ORF54 mutants was demonstrated by recombineering single-nucleotide changes within ORF54 that conferred resistance to VZV-specific portal protein inhibitors. IMPORTANCE Antivirals with novel mechanisms of action would provide additional therapeutic options to treat human herpesvirus infections. Proteins involved in the herpesviral DNA encapsidation process have become promising antiviral targets

  10. Analysis of single nucleotide polymorphism among Varicella-Zoster Virus and identification of vaccine-specific sites.

    PubMed

    Jeon, Jeong Seon; Won, Youn Hee; Kim, In Kyo; Ahn, Jin Hyun; Shin, Ok Sarah; Kim, Jung Hwan; Lee, Chan Hee

    2016-09-01

    Varicella-zoster virus (VZV) is a causative agent for chickenpox and zoster. Live attenuated vaccines have been developed based on Oka and MAV/06 strains. In order to understand the molecular mechanisms of attenuation, complete genome sequences of vaccine and wild-type strains were compared and single nucleotide polymorphism (SNP) was analyzed. ORF22 and ORF62 contained the highest number of SNPs. The detailed analysis of the SNPs suggested 24 potential vaccine-specific sites. All the mutational events found in vaccine-specific sites were transitional, and most of them were substitution of AT to GC pair. Interestingly, 18 of the vaccine-specific sites of the vaccine strains appeared to be genetically heterogeneous. The probability of a single genome of vaccine strain to contain all 24 vaccine-type sequences was calculated to be less than 4%. The average codon adaptation index (CAI) value of the vaccine strains was significantly lower than the CAI value of the clinical strains. PMID:27376245

  11. Integrating between-host transmission and within-host immunity to analyze the impact of varicella vaccination on zoster.

    PubMed

    Ogunjimi, Benson; Willem, Lander; Beutels, Philippe; Hens, Niel

    2015-01-01

    Varicella-zoster virus (VZV) causes chickenpox and reactivation of latent VZV causes herpes zoster (HZ). VZV reactivation is subject to the opposing mechanisms of declining and boosted VZV-specific cellular mediated immunity (CMI). A reduction in exogenous re-exposure 'opportunities' through universal chickenpox vaccination could therefore lead to an increase in HZ incidence. We present the first individual-based model that integrates within-host data on VZV-CMI and between-host transmission data to simulate HZ incidence. This model allows estimating currently unknown pivotal biomedical parameters, including the duration of exogenous boosting at 2 years, with a peak threefold to fourfold increase of VZV-CMI; the VZV weekly reactivation probability at 5% and VZV subclinical reactivation having no effect on VZV-CMI. A 100% effective chickenpox vaccine given to 1 year olds would cause a 1.75 times peak increase in HZ 31 years after implementation. This increase is predicted to occur mainly in younger age groups than is currently assumed. PMID:26259874

  12. Development and Validation of a Gamma Interferon ELISPOT Assay for Quantitation of Cellular Immune Responses to Varicella-Zoster Virus

    PubMed Central

    Smith, Jeffrey G.; Liu, Xu; Kaufhold, Robin M.; Clair, James; Caulfield, Michael J.

    2001-01-01

    Cell-mediated immunity appears to be critical for the prevention and control of varicella-zoster virus (VZV) infection and complications arising from zoster. Current assays of VZV-specific cell-mediated immunity are cumbersome or lack sensitivity. We have developed a gamma interferon ELISPOT assay that provides a direct measure of the number of T cells secreting a cytokine following stimulation with antigen. This assay is extremely sensitive and specific, with the ability to detect gamma interferon spot-forming cells (SFC) in the range of 10 to 1,000 SFC per million peripheral blood mononuclear cells (PBMCs). This assay has been validated by demonstrating the following: (i) the response detected is mediated almost entirely by CD4+ T cells, (ii) ELISPOT responses from fresh-frozen PBMCs are equivalent to those from freshly isolated cells, (iii) frozen PBMCs can be shipped on dry ice for up to 48 h without loss of activity, (iv) frozen PBMC samples can be stored in liquid nitrogen over long periods (>22 months) without any significant change in response, and (v) the numbers of ELISPOTs counted using a computer-based imaging system are equivalent to those counted by humans but have lower variability. The ability to use frozen cells is facilitated by the use of a recombinant nuclease (Benzonase) that can prevent cell clumping when samples are thawed. Frozen PBMC samples can be cycled through multiple changes in storage between liquid nitrogen and dry ice without any change in response being detected. This facilitates collection of samples at one site and testing performed at a remote location. This VZV ELISPOT assay provides a new versatile tool for monitoring cellular immune responses either during a herpes zoster disease outbreak or following vaccination. PMID:11527795

  13. Magnetic Resonance Imaging Evidence of Varicella Zoster Virus Polyneuropathy: Involvement of the Glossopharyngeal and Vagus Nerves Associated With Ramsay Hunt Syndrome.

    PubMed

    Gunbey, Hediye Pinar; Kutlar, Gokhan; Aslan, Kerim; Sayit, Asli Tanrivermis; Incesu, Lutfi

    2016-05-01

    The involvement of lower cranial nerve palsies is less frequent in Ramsay Hunt syndrome caused by varicella zoster virus (VZV). The authors report 1 of extremely rare patients of radiologically proven polyneuropathy of VZV infection with magnetic resonance imaging findings of VII, IX, and X cranial nerve involvement is a 62-year-old female patient, who initially presented with Ramsay Hunt syndrome. Varicella zoster virus infection should be considered even in patients who show unilateral palsy of the lower cranial nerves associated with laryngeal paralysis. Thin-section T2W and T1W images with a contrast agent should be added to the imaging protocol to show the subtle involvement. PMID:27092925

  14. Disseminated, Persistent, and Fatal Infection Due to the Vaccine Strain of Varicella-Zoster Virus in an Adult Following Stem Cell Transplantation

    PubMed Central

    Bhalla, Preeti; Forrest, Graeme N.; Gershon, Michael; Zhou, Yan; Chen, Jason; LaRussa, Philip; Steinberg, Sharon; Gershon, Anne A.

    2015-01-01

    Live attenuated varicella vaccine is recommended for healthy individuals who are susceptible to varicella. Although the vaccine is safe, effective, and used worldwide, serious adverse events have been reported, mainly in immunocompromised patients who subsequently recovered. Here, we describe the fatality of an immunocompromised patient who received the varicella vaccine. His medical history provides a cautionary lens through which to view the decision of when vaccination is appropriate. A middle-aged man with non-Hodgkin lymphoma received chemotherapy and a stem cell transplant. He was vaccinated 4 years post-transplantation, despite diagnosis of a new low-grade lymphoma confined to the lymph nodes. Within 3 months of vaccination, he developed recurrent rashes with fever, malaise, weakness, hepatitis, weight loss, and renal failure. The syndrome was eventually determined to be associated with persistent disseminated zoster caused by the vaccine virus. This case illustrates a circumstance when a live viral vaccine should not be used. PMID:25452596

  15. [Acute pancreatitis caused by varicella-zoster virus after liver transplantation].

    PubMed

    Coelho, J C; Wiederkehr, J C; Campos, A C; Zeni Neto, C; Oliva, V

    1994-02-01

    Twenty-six days after liver transplantation for primary biliary cirrhosis, a 52 year-old patient was rehospitalized for viral infection. The clinical features were fatigue, anorexia and vomiting. On physical examination, vesicular skin lesions involving the left 8 th intercostal space were suggestive of herpes-zoster infection. The following day the patient was extremely tired and dyspnoeic. The abdomen was distended with moderate abdominal epigastric pain. The clinical picture worsened rapidly and the patient died a few hours later. Autopsy revealed acute haemorrhagic necrosis of the pancreas due to herpes-zoster virus. PMID:8207103

  16. Enzymatic Digestion Pattern of Varicella Zoster Virus ORF38 and ORF54 in Chickenpox Patients Using RFLP Technique

    PubMed Central

    Safarnezhad Tameshkel, Fahimeh; Karbalaie Niya, Mohammad Hadi; Keyvani, Hossein

    2016-01-01

    Background: Varicella zoster virus (VZV) causes chickenpox in children and zoster (zona) in the elderly. Using RFLP-PCR method for detection of VZV specific SNPs ORF38, 54 and 62 could distinguish the profile of VZV isolates. The aim of this study was to investigate enzymatic digestion pattern of VZV ORF38 and ORF54 in chickenpox patients using RFLP technique. Methods: Thirty-eight chickenpox patients, who referred to the hospitals of Iran University of Medical Sciences in Tehran from May 2010 to June 2015 were enrolled in this cross sectional study. After the DNA extraction, PCR amplification of 38 VZV isolates performed by specific primers of ORFs 38 and 54, then RFLP assay and digestion carried out by PstI (for ORF38) and BglI (for ORF54) restriction enzymes. Results: Of 38 positive VZV DNA, the mean age (yr)±SD was 34.4±23.3 (range: 7-89). 22 (57.9%) were female and 16 (42.1%) were male. The predominant VZV profile of BglI+PstI+ were 89.5% (34/38) followed by 10.5% (4/38) PstI+BglI‾. Statistical analysis showed that there was no significant relationship between genotype, age, sex, and year of infection variables (P value> 0.05). The common VZV genotype among Iranian patients with chickenpox and zona infection is genotype BglI+PstI+ followed by PstI+BglI‾. Conclusion: There are different VZV circulating genotypes that call for for more research on this field by widely population and other methods such as nucleotide sequencing to justify the accurate VZV genotype prevalence in Iran. PMID:26870141

  17. Structure of the Varicella Zoster Virus Thymidylate Synthase Establishes Functional and Structural Similarities as the Human Enzyme and Potentiates Itself as a Target of Brivudine.

    PubMed

    Hew, Kelly; Dahlroth, Sue-Li; Veerappan, Saranya; Pan, Lucy Xin; Cornvik, Tobias; Nordlund, Pär

    2015-01-01

    Varicella zoster virus (VZV) is a highly infectious human herpesvirus that is the causative agent for chicken pox and shingles. VZV encodes a functional thymidylate synthase (TS), which is the sole enzyme that produces dTMP from dUMP de novo. To study substrate binding, the complex structure of TSVZV with dUMP was determined to a resolution of 2.9 Å. In the absence of a folate co-substrate, dUMP binds in the conserved TS active site and is coordinated similarly as in the human encoded TS (TSHS) in an open conformation. The interactions between TSVZV with dUMP and a cofactor analog, raltitrexed, were also studied using differential scanning fluorimetry (DSF), suggesting that TSVZV binds dUMP and raltitrexed in a sequential binding mode like other TS. The DSF also revealed interactions between TSVZV and in vitro phosphorylated brivudine (BVDUP), a highly potent anti-herpesvirus drug against VZV infections. The binding of BVDUP to TSVZV was further confirmed by the complex structure of TSVZV and BVDUP solved at a resolution of 2.9 Å. BVDUP binds similarly as dUMP in the TSHS but it induces a closed conformation of the active site. The structure supports that the 5-bromovinyl substituent on BVDUP is likely to inhibit TSVZV by preventing the transfer of a methylene group from its cofactor and the subsequent formation of dTMP. The interactions between TSVZV and BVDUP are consistent with that TSVZV is indeed a target of brivudine in vivo. The work also provided the structural basis for rational design of more specific TSVZV inhibitors. PMID:26630264

  18. Structure of the Varicella Zoster Virus Thymidylate Synthase Establishes Functional and Structural Similarities as the Human Enzyme and Potentiates Itself as a Target of Brivudine

    PubMed Central

    Hew, Kelly; Dahlroth, Sue-Li; Veerappan, Saranya; Pan, Lucy Xin; Cornvik, Tobias; Nordlund, Pär

    2015-01-01

    Varicella zoster virus (VZV) is a highly infectious human herpesvirus that is the causative agent for chicken pox and shingles. VZV encodes a functional thymidylate synthase (TS), which is the sole enzyme that produces dTMP from dUMP de novo. To study substrate binding, the complex structure of TSVZV with dUMP was determined to a resolution of 2.9 Å. In the absence of a folate co-substrate, dUMP binds in the conserved TS active site and is coordinated similarly as in the human encoded TS (TSHS) in an open conformation. The interactions between TSVZV with dUMP and a cofactor analog, raltitrexed, were also studied using differential scanning fluorimetry (DSF), suggesting that TSVZV binds dUMP and raltitrexed in a sequential binding mode like other TS. The DSF also revealed interactions between TSVZV and in vitro phosphorylated brivudine (BVDUP), a highly potent anti-herpesvirus drug against VZV infections. The binding of BVDUP to TSVZV was further confirmed by the complex structure of TSVZV and BVDUP solved at a resolution of 2.9 Å. BVDUP binds similarly as dUMP in the TSHS but it induces a closed conformation of the active site. The structure supports that the 5-bromovinyl substituent on BVDUP is likely to inhibit TSVZV by preventing the transfer of a methylene group from its cofactor and the subsequent formation of dTMP. The interactions between TSVZV and BVDUP are consistent with that TSVZV is indeed a target of brivudine in vivo. The work also provided the structural basis for rational design of more specific TSVZV inhibitors. PMID:26630264

  19. Deletion of the varicella-zoster virus large subunit of ribonucleotide reductase impairs growth of virus in vitro.

    PubMed Central

    Heineman, T C; Cohen, J I

    1994-01-01

    Cells infected with varicella-zoster virus (VZV) express a viral ribonucleotide reductase which is distinct from that present in uninfected cells. VZV open reading frames 18 and 19 (ORF18 and ORF19) are homologous to the herpes simplex virus type 1 genes encoding the small and large subunits of ribonucleotide reductase, respectively. We generated recombinant VZV by transfecting cultured cells with four overlapping cosmid DNAs. To construct a virus lacking ribonucleotide reductase, we deleted 97% of VZV ORF19 from one of the cosmids. Transfection of this cosmid with the other parental cosmids yielded a VZV mutant with a 2.3-kbp deletion confirmed by Southern blot analysis. Virus-specific ribonucleotide reductase activity was not detected in cells infected with VZV lacking ORF19. Infection of melanoma cells with ORF19-deleted VZV resulted in plaques smaller than those produced by infection with the parental VZV. The mutant virus also exhibited a growth rate slightly slower than that of the parental virus. Chemical inhibition of the VZV ribonucleotide reductase has been shown to potentiate the anti-VZV activity of acyclovir. Similarly, the concentration of acyclovir required to inhibit plaque formation by 50% was threefold lower for the VZV ribonucleotide reductase deletion mutants than for parental virus. We conclude that the VZV ribonucleotide reductase large subunit is not essential for virus infection in vitro; however, deletion of the gene impairs the growth of VZV in cell culture and renders the virus more susceptible to inhibition by acyclovir. Images PMID:8151792

  20. Varicella-zoster virus open reading frame 4 encodes an immediate-early protein with posttranscriptional regulatory properties.

    PubMed Central

    Defechereux, P; Debrus, S; Baudoux, L; Rentier, B; Piette, J

    1997-01-01

    Varicella-zoster virus (VZV) encodes four putative immediate-early proteins based on sequence homology with herpes simplex virus type 1: the products of ORF4, -61, -62, and -63. Until now, only two VZV proteins have been described as being truly expressed with immediate-early kinetics (IE62 and IE63). The ORF4-encoded protein can stimulate gene expression either alone or in synergy with the major regulatory protein IE62. Making use of a sequential combination of transcription and protein synthesis inhibitors (actinomycin D and cycloheximide, respectively), we demonstrated the immediate-early nature of the ORF4 gene product, which can thus be named IE4. The fact that IE4 is expressed with kinetics similar to that of IE62 further underlines the possible cooperation between these two VZV proteins in gene expression. Analysis of the IE4-mediated autologous or heterologous viral gene expression at the mRNA levels clearly indicated that IE4 may have several mechanisms of action. Activation of the two VZV genes tested could occur partly by a posttranscriptional mechanism, since increases in chloramphenicol acetyltransferase (CAT) mRNA levels do not account for the stimulation of CAT activity. On the other hand, stimulation of the human immunodeficiency virus type 1 long terminal repeat- or the cytomegalovirus promoter-associated CAT activity is correlated with an increase in the corresponding CAT mRNA. PMID:9261438

  1. An In Vitro Model of Latency and Reactivation of Varicella Zoster Virus in Human Stem Cell-Derived Neurons

    PubMed Central

    Markus, Amos; Lebenthal-Loinger, Ilana; Yang, In Hong; Kinchington, Paul R.; Goldstein, Ronald S.

    2015-01-01

    Varicella zoster virus (VZV) latency in sensory and autonomic neurons has remained enigmatic and difficult to study, and experimental reactivation has not yet been achieved. We have previously shown that human embryonic stem cell (hESC)-derived neurons are permissive to a productive and spreading VZV infection. We now demonstrate that hESC-derived neurons can also host a persistent non-productive infection lasting for weeks which can subsequently be reactivated by multiple experimental stimuli. Quiescent infections were established by exposing neurons to low titer cell-free VZV either by using acyclovir or by infection of axons in compartmented microfluidic chambers without acyclovir. VZV DNA and low levels of viral transcription were detectable by qPCR for up to seven weeks. Quiescently-infected human neuronal cultures were induced to undergo renewed viral gene and protein expression by growth factor removal or by inhibition of PI3-Kinase activity. Strikingly, incubation of cultures induced to reactivate at a lower temperature (34°C) resulted in enhanced VZV reactivation, resulting in spreading, productive infections. Comparison of VZV genome transcription in quiescently-infected to productively-infected neurons using RNASeq revealed preferential transcription from specific genome regions, especially the duplicated regions. These experiments establish a powerful new system for modeling the VZV latent state, and reveal a potential role for temperature in VZV reactivation and disease. PMID:26042814

  2. Adaptive Immune Responses in a Multiple Sclerosis Patient with Acute Varicella-Zoster Virus Reactivation during Treatment with Fingolimod

    PubMed Central

    Harrer, Andrea; Wipfler, Peter; Pilz, Georg; Oppermann, Katrin; Haschke-Becher, Elisabeth; Afazel, Shahrzad; Kraus, Jörg; Trinka, Eugen; Sellner, Johann

    2015-01-01

    Fingolimod, an oral sphingosine 1-phosphate (S1P) receptor modulator, is approved for the treatment of relapsing forms of multiple sclerosis (MS). The interference with S1P signaling leads to retention particularly of chemokine receptor-7 (CCR7) expressing T cells in lymph nodes. The immunological basis of varicella zoster virus (VZV) infections during fingolimod treatment is unclear. Here, we studied the dynamics of systemic and intrathecal immune responses associated with symptomatic VZV reactivation including cessation of fingolimod and initiation of antiviral therapy. Key features in peripheral blood were an about two-fold increase of VZV-specific IgG at diagnosis of VZV reactivation as compared to the previous months, a relative enrichment of effector CD4+ T cells (36% versus mean 12% in controls), and an accelerated reconstitution of absolute lymphocytes counts including a normalized CD4+/CD8+ ratio and reappearance of CCR7+ T cells. In cerebrospinal fluid (CSF) the lymphocytic pleocytosis and CD4+/CD8+ ratios at diagnosis of reactivation and after nine days of fingolimod discontinuation remained unchanged. During this time CCR7+ T cells were not observed in CSF. Further research into fingolimod-associated VZV reactivation and immune reconstitution is mandatory to prevent morbidity and mortality associated with this potentially life-threatening condition. PMID:26378517

  3. Phosphorylation of varicella-zoster virus glycoprotein gpI by mammalian casein kinase II and casein kinase I

    SciTech Connect

    Grose, C.; Jackson, W. ); Traugh, J.A. )

    1989-09-01

    Varicella-zoster virus (VZV) glycoprotein gpI is the predominant viral glycoprotein within the plasma membranes of infected cells. This viral glycoprotein is phosphorylated on its polypeptide backbone during biosynthesis. In this report, the authors investigated the protein kinases which participate in the phosphorylation events. Under in vivo conditions, VZV gpI was phosphorylated on its serine and threonine residues by protein kinases present within lysates of either VZV-infected or uninfected cells. Because this activity was diminished by heparin, a known inhibitor of casein kinase II, isolated gpI was incubated with purified casein kinase II and shown to be phosphorylated in an in vitro assay containing ({gamma}-{sup 32}P)ATP. The same glycoprotein was phosphorylated when ({sup 32}P)GTP was substituted for ({sup 32}P)ATP in the protein kinase assay. They also tested whether VZV gpI was phosphorylated by two other ubiquitous mammalian protein kinases--casein kinase I and cyclic AMP-dependent kinase--and found that only casein kinase I modified gpI. When the predicted 623-amino-acid sequence of gpI was examined, two phosphorylation sites known to be optimal for casein kinase II were observed. In summary, this study showed that VZV gpI was phosphorylated by each of two mammalian protein kinases (casein kinase I and casein kinase II) and that potential serine-threonine phosphorylation sites for each of these two kinases were present in the viral glycoprotein.

  4. MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE

    PubMed Central

    CORTI, Marcelo; VILLAFAÑE, María F.; VITTAR, Natalia; BANCO, María C.; PRIARONE, Maia; MAMMANA, Lilia; GILARDI, Leonardo

    2015-01-01

    Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease. PMID:27049704

  5. RNA-seq Analysis of Host and Viral Gene Expression Highlights Interaction between Varicella Zoster Virus and Keratinocyte Differentiation

    PubMed Central

    Singh, Manuraj; Kanda, Ravinder K.; Yee, Michael B.; Kellam, Paul; Hollinshead, Michael; Kinchington, Paul R.; O'Toole, Edel A.; Breuer, Judith

    2014-01-01

    Varicella zoster virus (VZV) is the etiological agent of chickenpox and shingles, diseases characterized by epidermal skin blistering. Using a calcium-induced keratinocyte differentiation model we investigated the interaction between epidermal differentiation and VZV infection. RNA-seq analysis showed that VZV infection has a profound effect on differentiating keratinocytes, altering the normal process of epidermal gene expression to generate a signature that resembles patterns of gene expression seen in both heritable and acquired skin-blistering disorders. Further investigation by real-time PCR, protein analysis and electron microscopy revealed that VZV specifically reduced expression of specific suprabasal cytokeratins and desmosomal proteins, leading to disruption of epidermal structure and function. These changes were accompanied by an upregulation of kallikreins and serine proteases. Taken together VZV infection promotes blistering and desquamation of the epidermis, both of which are necessary to the viral spread and pathogenesis. At the same time, analysis of the viral transcriptome provided evidence that VZV gene expression was significantly increased following calcium treatment of keratinocytes. Using reporter viruses and immunohistochemistry we confirmed that VZV gene and protein expression in skin is linked with cellular differentiation. These studies highlight the intimate host-pathogen interaction following VZV infection of skin and provide insight into the mechanisms by which VZV remodels the epidermal environment to promote its own replication and spread. PMID:24497829

  6. Insights into the role of immunosenescence during varicella zoster virus infection (shingles) in the aging cell model

    PubMed Central

    Kumar, Mukesh; Lee, Chan-Hee; Shin, Ok Sarah

    2015-01-01

    Varicella zoster virus (VZV) is the etiological agent of shingles, a painful skin rash that affects a significant proportion of the elderly population. In the present study, we used two aging cell models, Hutchinson-Gilford progeria syndrome (HGPS) fibroblasts and stress or replicative senescence-induced normal human dermal fibroblasts (NHDFs), to investigate age-associated susceptibility to VZV infection. VZV infectivity titers were significantly associated with donor age in HGPS fibroblasts and senescence induction in NHDFs. High throughput RNA-sequencing (RNA-seq) analysis was performed to assess global and dynamic changes in the host transcriptomes of VZV-infected aging cells. Analysis of differentially expressed genes (DEGs) indicated that VZV infection in aged HGPS fibroblasts resembled that in senescent NHDFs, particularly in terms of genes associated with pattern recognition receptors in virus sensing network, providing novel insights into the mechanisms of senescence-associated susceptibility to VZV infection. Additionally, we identified stimulator of interferon genes (STING) as a potential VZV sensing receptor. Knockdown of STING expression resulted in increased viral replication in primary fibroblasts, whereas STING overexpression led to suppression of VZV plaque formation. In conclusion, our findings highlight the important role of immunosenescence following VZV infection and provide significant insights into the mechanisms underlying cellular sensing of VZV infection and the induction of immune responses in aged skin cells. PMID:26473290

  7. Direct Transfer of Viral and Cellular Proteins from Varicella-Zoster Virus-Infected Non-Neuronal Cells to Human Axons

    PubMed Central

    Grigoryan, Sergei; Yee, Michael B; Glick, Yair; Gerber, Doron; Kepten, Eldad; Garini, Yuval; Yang, In Hong; Kinchington, Paul R.; Goldstein, Ronald S.

    2015-01-01

    Varicella Zoster Virus (VZV), the alphaherpesvirus that causes varicella upon primary infection and Herpes zoster (shingles) following reactivation in latently infected neurons, is known to be fusogenic. It forms polynuclear syncytia in culture, in varicella skin lesions and in infected fetal human ganglia xenografted to mice. After axonal infection using VZV expressing green fluorescent protein (GFP) in compartmentalized microfluidic cultures there is diffuse filling of axons with GFP as well as punctate fluorescence corresponding to capsids. Use of viruses with fluorescent fusions to VZV proteins reveals that both proteins encoded by VZV genes and those of the infecting cell are transferred in bulk from infecting non-neuronal cells to axons. Similar transfer of protein to axons was observed following cell associated HSV1 infection. Fluorescence recovery after photobleaching (FRAP) experiments provide evidence that this transfer is by diffusion of proteins from the infecting cells into axons. Time-lapse movies and immunocytochemical experiments in co-cultures demonstrate that non-neuronal cells fuse with neuronal somata and proteins from both cell types are present in the syncytia formed. The fusogenic nature of VZV therefore may enable not only conventional entry of virions and capsids into axonal endings in the skin by classical entry mechanisms, but also by cytoplasmic fusion that permits viral protein transfer to neurons in bulk. PMID:25973990

  8. PROTECTIVE LEVELS OF VARICELLA-ZOSTER ANTIBODY DID NOT EFFECTIVELY PREVENT CHICKENPOX IN AN X-LINKED AGAMMAGLOBULINEMIA PATIENT.

    PubMed

    Nobre, Fernanda Aimée; Gonzalez, Isabela Garrido da Silva; de Moraes-Pinto, Maria Isabel; Costa-Carvalho, Beatriz Tavares

    2015-01-01

    We describe the case of an eight-year-old boy with X-linked agammaglobulinemia who developed mild varicella despite regular intravenous immunoglobulin (IVIG) therapy. He maintained protective antibody levels against varicella and the previous batches of IVIG that he received had adequate varicella-specific IgG levels. The case illustrates that IVIG may not prevent VZV infection. PMID:26603238

  9. PROTECTIVE LEVELS OF VARICELLA-ZOSTER ANTIBODY DID NOT EFFECTIVELY PREVENT CHICKENPOX IN AN X-LINKED AGAMMAGLOBULINEMIA PATIENT

    PubMed Central

    NOBRE, Fernanda Aimée; GONZALEZ, Isabela Garrido da Silva; de MORAES-PINTO, Maria Isabel; COSTA-CARVALHO, Beatriz Tavares

    2015-01-01

    SUMMARY We describe the case of an eight-year-old boy with X-linked agammaglobulinemia who developed mild varicella despite regular intravenous immunoglobulin (IVIG) therapy. He maintained protective antibody levels against varicella and the previous batches of IVIG that he received had adequate varicella-specific IgG levels. The case illustrates that IVIG may not prevent VZV infection. PMID:26603238

  10. Household size is critical to varicella-zoster virus transmission in the tropics despite lower viral infectivity

    PubMed Central

    Nichols, Richard A.; Averbeck, Karin T.; Poulsen, Anja G.; al Bassam, Mahmoud M.; Cabral, Fernando; Aaby, Peter; Breuer, Judith

    2011-01-01

    The epidemiology and severity of infections can vary dramatically in different geographical regions. Varicella zoster virus (VZV) is a particularly tractable model for investigating such global differences, since infections can be unambiguously identified. VZV is spread by aerosol to cause chickenpox, which, in temperate countries, is a relatively benign childhood infection; yet in tropical countries it tends to occur at later age, a trend associated with markedly increased severity including complications, hospitalization, and overall burden of care. To investigate global differences in the epidemiology of chickenpox we studied a population in Guinea Bissau, which in contrast to other tropical countries has an unexpectedly early age of infection with VZV, comparable to temperate latitudes. In this study we used detailed records from over 3000 houses during an outbreak of chickenpox, combined with viral genetic information on routes of infection, to obtain precise estimates of disease transmission within and between houses. This community contains many large households in which different families live under a single roof, in living quarters divided by partitions. Our data show that household infectivity in tropical Guinea Bissau is reduced four-fold compared with temperate climates (14.8% versus 61–85%), with an intermediate rate between members of the same family who are in more intimate contact (23.5%). All else being equal, these lower infection rates would be expected to lead to a later age of infection as is commonly seen in other tropical countries. The young age of infection, which had drawn our attention to the Guinea Bissau population, can however be explained by the exceptionally large household sizes (mean 14.5 people). We have combined genetic and demographic data to show that the epidemiology of chickenpox in tropical Guinea Bissau is dependent on the interaction of the social and physical environments. The distinctive clinical presentation of VZV

  11. Open Reading Frame S/L of Varicella-Zoster Virus Encodes a Cytoplasmic Protein Expressed in Infected Cells

    PubMed Central

    Kemble, George W.; Annunziato, Paula; Lungu, Octavian; Winter, Ruth E.; Cha, Tai-An; Silverstein, Saul J.; Spaete, Richard R.

    2000-01-01

    We report the discovery of a novel gene in the varicella-zoster virus (VZV) genome, designated open reading frame (ORF) S/L. This gene, located at the left end of the prototype VZV genome isomer, expresses a polyadenylated mRNA containing a splice within the 3′ untranslated region in virus-infected cells. Sequence analysis reveals significant differences between the ORF S/Ls of wild-type and attenuated strains of VZV. Antisera raised to a bacterially expressed portion of ORF S/L reacted specifically with a 21-kDa protein synthesized in cells infected with a VZV clinical isolate and with the original vaccine strain of VZV (Oka-ATCC). Cells infected with other VZV strains, including a wild-type strain that has been extensively passaged in tissue culture and commercially produced vaccine strains of Oka, synthesize a family of proteins ranging in size from 21 to 30 kDa that react with the anti-ORF S/L antiserum. MeWO cells infected with recombinant VZV harboring mutations in the C-terminal region of the ORF S/L gene lost adherence to the stratum and adjacent cells, resulting in an altered plaque morphology. Immunohistochemical analysis of VZV-infected cells demonstrated that ORF S/L protein localizes to the cytoplasm. ORF S/L protein was present in skin lesions of individuals with primary or reactivated infection and in the neurons of a dorsal root ganglion during virus reactivation. PMID:11070031

  12. Complex Formation Facilitates Endocytosis of the Varicella-Zoster Virus gE:gI Fc Receptor

    PubMed Central

    Olson, Julie K.; Grose, Charles

    1998-01-01

    Open reading frames within the unique short segment of alphaherpesvirus genomes participate in egress and cell-to-cell spread. The case of varicella-zoster virus (VZV) is of particular interest not only because the virus is highly cell associated but also because its most prominent cell surface protein, gE, bears semblance to the mammalian Fc receptor FcγRII. A previous study demonstrated that when expressed alone in cells, VZV gE was endocytosed from the cell surface through a tyrosine localization motif in its cytoplasmic tail (J. K. Olson and C. Grose, J. Virol. 71:4042–4054, 1997). Since VZV gE is normally found in association with gI in the infected cell, the present study was directed at defining the trafficking of the VZV gE:gI protein complex. First, VZV gI underwent endocytosis and recycling when it was expressed alone in cells, and interestingly, VZV gI contained a methionine-leucine internalization motif in its cytoplasmic tail. Second, VZV gI was found by confocal microscopy to colocalize with VZV gE during endocytosis and recycling in cells. Third, by a quantitative internalization assay, VZV gE:gI was shown to undergo endocytosis more efficiently (steady state, 55 to 60%) than either gE alone (steady state, ∼32%) or gI alone (steady state, ∼45%). Further, examination of endocytosis-deficient mutant proteins demonstrated that VZV gI exerted a more pronounced effect than gE on internalization of the complex. Most importantly, therefore, these studies suggest that VZV gI behaves as an accessory component by facilitating the endocytosis of the major constituent gE and thereby modulating the trafficking of the entire cell surface gE:gI Fc receptor complex. PMID:9445058

  13. Varicella-Zoster Virus ORF12 Protein Triggers Phosphorylation of ERK1/2 and Inhibits Apoptosis

    PubMed Central

    Liu, XueQiao; Li, Qingxue; Dowdell, Kennichi; Fischer, Elizabeth R.

    2012-01-01

    Mitogen-activated protein kinases (MAPKs) are a family of serine-threonine protein kinases involved in many cellular processes, including cell proliferation, differentiation, inflammation, and cell death. Activation of several MAPKs, including extracellular signal-regulated kinase 1 and 2 (ERK1/2), p38, and c-Jun N-terminal kinase (JNK), results in stimulation of activator protein 1 (AP-1), which promotes gene transcription. Previous studies have demonstrated that varicella-zoster virus (VZV) infection activates ERK1/2, p38, and JNK to promote viral replication, but the underlying mechanism(s) is unclear. To identify viral proteins responsible for the activation of MAPK, we used a proteomic approach to screen viral proteins for AP-1 promoter activation by an AP-1–luciferase reporter assay. We found that VZV ORF12 protein, located in the tegument of virions, enhances AP-1 reporter activity. This effect of ORF12 protein was markedly inhibited by a MAPK/ERK kinase 1 and 2 (MEK1/2) inhibitor (U0126), partially blocked by a p38 inhibitor (SB202190), but not inhibited by a JNK inhibitor (SP600125). Expression of VZV ORF12 protein in cells resulted in phosphorylation of ERK1/2 and p38 but not JNK. Infection of cells with a VZV ORF12 deletion mutant resulted in reduced levels of phosphorylated ERK1/2 (p-ERK1/2) compared to infection with wild-type VZV. Furthermore, deletion of ORF12 rendered VZV-infected cells more susceptible to staurosporine-induced apoptosis. In conclusion, VZV ORF12 protein activates the AP-1 pathway by selectively triggering the phosphorylation of ERK1/2 and p38. Cells infected with a VZV ORF12 deletion mutant have reduced levels of p-ERK1/2 and are more susceptible to apoptosis than cells infected with wild-type VZV. PMID:22238304

  14. Comparison of biotinylated DNA and RNA probes for rapid detection of varicella-zoster virus genome by in situ hybridization.

    PubMed Central

    Forghani, B; Yu, G J; Hurst, J W

    1991-01-01

    We describe a general method for the production of nonisotopic DNA and RNA probes for the detection of the varicella-zoster virus (VZV) genome by in situ hybridization. VZV DNA was extracted from purified viral nucleocapsids, cleaved with restriction enzyme (RE) BamHI, and cloned into plasmid pBR322 by the standard vector insert procedure. We cloned over 85% of the VZV genome and obtained 18 recombinants. Plasmids containing the B, F, G, H, and J fragments of VZV DNA were labeled by the nick translation method with biotin-11-dUTP as the dTTP analog. Additionally, the B fragment was cleaved with RE AvaI, subcloned into the plasmid pGEM-4 transcription vector, and subsequently linearized with REs PstI and EcoRI. RNA was transcribed with T7 or SP6 polymerase, with a substitution of allylamine-UTP as the UTP analog, and labeled with epsilon-caproylamidobiotin-N-hydroxysuccinimide ester. The DNA and RNA probes were used under full-stringency conditions for in situ hybridization with alkaline phosphatase as the detector and 5-bromo-4-chloro-3-indolyl phosphate-Nitro Blue Tetrazolium as the substrate. When tested under comparable conditions, the RNA probe was slightly more sensitive than was the DNA probe: both probes showed homology only with VZV-infected cells and clinical tissues and not with the other herpesviruses. Probes prepared from variable regions of the genome (fragments F and J) performed as well as did those from conserved regions (fragments B. G. and H). Biotinylated probes have distinct advantages over isotopic probes and retain their full potency for more than 2 years when stored properly. Images PMID:1645371

  15. Development of a Bead-Based Multiplex Immunoassay for Simultaneous Quantitative Detection of IgG Serum Antibodies against Measles, Mumps, Rubella, and Varicella-Zoster Virus

    PubMed Central

    van Gageldonk, Pieter G.; Schouls, Leo M.; van der Klis, Fiona R. M.; Berbers, Guy A. M.

    2012-01-01

    Enzyme-linked immunosorbent assay (ELISA) is normally used to quantify the amount of serum IgG antibodies against measles, mumps, rubella, and varicella-zoster virus (MMRV). However, this method is time- and material-consuming. Therefore, a multiplex immunoassay for the simultaneous quantitative detection of antibodies against MMRV was developed. In-house as well as commercially available antigens can be used, making the assay available for all laboratories. The multiplex assay is much more sensitive than the separate ELISAs and has a high specificity, and only 5 μl of serum is needed. Heterologous inhibition did not exceed 11.5%, while homologous inhibition varied between 91.3 and 97.9%. Good correlations with the in-house ELISAs for measles (R2 = 0.98), mumps (R2 = 0.97), and rubella (R2 = 0.97) virus as well as with the ELISA kit for varicella-zoster virus (R2 = 0.95) were obtained. In conclusion, the MMRV multiplex assay is a good alternative to the conventional ELISAs and suitable for use in serosurveillance and vaccine studies. PMID:22237896

  16. Insulin Degrading Enzyme Induces a Conformational Change in Varicella-Zoster Virus gE, and Enhances Virus Infectivity and Stability

    PubMed Central

    Li, Qingxue; Ali, Mir A.; Wang, Kening; Sayre, Dean; Hamel, Frederick G.; Fischer, Elizabeth R.; Bennett, Robert G.; Cohen, Jeffrey I.

    2010-01-01

    Varicella-zoster virus (VZV) glycoprotein E (gE) is essential for virus infectivity and binds to a cellular receptor, insulin-degrading enzyme (IDE), through its unique amino terminal extracellular domain. Previous work has shown IDE plays an important role in VZV infection and virus cell-to-cell spread, which is the sole route for VZV spread in vitro. Here we report that a recombinant soluble IDE (rIDE) enhances VZV infectivity at an early step of infection associated with an increase in virus internalization, and increases cell-to-cell spread. VZV mutants lacking the IDE binding domain of gE were impaired for syncytia formation and membrane fusion. Pre-treatment of cell-free VZV with rIDE markedly enhanced the stability of the virus over a range of conditions. rIDE interacted with gE to elicit a conformational change in gE and rendered it more susceptible to proteolysis. Co-incubation of rIDE with gE modified the size of gE. We propose that the conformational change in gE elicited by IDE enhances infectivity and stability of the virus and leads to increased fusogenicity during VZV infection. The ability of rIDE to enhance infectivity of cell-free VZV over a wide range of incubation times and temperatures suggests that rIDE may be useful for increasing the stability of varicella or zoster vaccines. PMID:20593027

  17. Interaction of allergy history and antibodies to specific varicella-zoster virus proteins on glioma risk.

    PubMed

    Lee, Seung-Tae; Bracci, Paige; Zhou, Mi; Rice, Terri; Wiencke, John; Wrensch, Margaret; Wiemels, Joseph

    2014-05-01

    Glioma is the most common cancer of the central nervous system but with few confirmed risk factors. It has been inversely associated with chicken pox, shingles and seroreactivity to varicella virus (VZV), as well as to allergies and allergy-associated IgE. The role of antibody reactivity against individual VZV antigens has not been assessed. Ten VZV-related proteins, selected for high immunogenicity or known function, were synthesized and used as targets for antibody measurements in the sera of 143 glioma cases and 131 healthy controls selected from the San Francisco Bay Area Adult Glioma Study. Glioma cases exhibited significantly reduced seroreactivity compared to controls for six antigens, including proteins IE63 [odds ratio (OR) = 0.26, 95% confidence interval (CI): 0.12-0.58, comparing lowest quartile to highest) and the VZV-unique protein ORF2p (OR = 0.44, 95% CI: 0.21-0.96, lowest quartile to highest). When stratifying the study population into those with low and high self-reported allergy history, VZV protein seroreactivity was only associated inversely with glioma among individuals self-reporting more than two allergies. The data provide insight into both allergy and VZV effects on glioma: strong anti-VZV reactions in highly allergic individuals are associated with reduced occurrence of glioma. This result suggests a role for specificity in the anti-VZV immunity in brain tumor suppression for both individual VZV antigens and in the fine-tuning of the immune response by allergy. Anti-VZV reactions may also be a biomarker of effective CNS immunosurveillance owing to the tropism of the virus. PMID:24127236

  18. Varicella-zoster virus-specific cytotoxic T lymphocytes (Tc): detection and frequency analysis of HLA class I-restricted Tc in human peripheral blood.

    PubMed Central

    Hickling, J K; Borysiewicz, L K; Sissons, J G

    1987-01-01

    The cytotoxic T-cell (Tc) response to varicella-zoster virus (VZV) is incompletely characterized. We investigated whether VZV-specific Tc restricted by class I products of the major histocompatibility complex can be generated from the peripheral blood of VZV-immune donors. Cell lines were established from peripheral blood lymphocytes (PBL) of seropositive donors by secondary in vitro restimulation. If cell-free VZV was used as the stimulating antigen, the resulting lines were predominantly CD4+ and did not show class I-restricted cytotoxicity; when autologous infected fibroblasts were used for in vitro stimulation, the resultant lines were usually cytotoxic, although in only 4 of 11 subjects tested was this cytotoxicity HLA restricted and virus specific. PBL were also tested for Tc activity without prior restimulation; VZV-specific Tc activity was only demonstrable in the PBL of a subject convalescent following zoster but not from subjects with recent varicella infection or from normal subjects. VZV-specific Tc precursor frequencies were then determined in six selected subjects by limiting-dilution analysis. A measurable frequency was detectable in four of the six seropositive subjects, ranging from 11/10(6) T cells in an asymptomatic carrier, to 63/10(6) T cells in a subject with recent zoster. We conclude that virus-specific major histocompatibility complex class I-restricted Tc precursors may be present in the peripheral blood of normal individuals seropositive for VZV but at a frequency lower than that for other herpesviruses with nonneuronal sites of latency. PMID:2822954

  19. Relief of pain induced by varicella-zoster virus in a rat model of post-herpetic neuralgia using a herpes simplex virus vector expressing enkephalin

    PubMed Central

    Guedon, J-MG; Zhang, M; Glorioso, JC; Goins, WF; Kinchington, PR

    2015-01-01

    Acute and chronic pain (post-herpetic neuralgia or PHN) are encountered in patients with herpes zoster that is caused by reactivation of varicella-zoster virus (VZV) from a state of neuronal latency. PHN is often refractory to current treatments, and additional strategies for pain relief are needed. Here we exploited a rat footpad model of PHN to show that herpes simplex virus (HSV) vector-mediated gene delivery of human preproenkephalin (vHPPE) effectively reduced chronic VZV-induced nocifensive indicators of pain. VZV inoculated at the footpad induced prolonged mechanical allodynia and thermal hyperalgesia that did not develop in controls or with ultraviolet light-inactivated VZV. Subsequent footpad administration of vHPPE relieved VZV-induced pain behaviors in a dose-dependent manner for extended periods, and prophylactic vector administration prevented VZV-induced pain from developing. Short-term pain relief following low-dose vHPPE administration could be effectively prolonged by vector re-administration. HPPE transcripts were increased three- to fivefold in ipsilateral ganglia, but not in the contralateral dorsal root ganglia. VZV hypersensitivity and its relief by vHPPE were not affected by peripheral delivery of opioid receptor agonist or antagonist, suggesting that the efficacy was mediated at the ganglion and/or spinal cord level. These results support further development of ganglionic expression of enkephalin as a novel treatment for the pain associated with Zoster. PMID:24830437

  20. Varicella-Zoster Virus and Herpes Simplex Virus 1 Differentially Modulate NKG2D Ligand Expression during Productive Infection

    PubMed Central

    Campbell, Tessa M.; McSharry, Brian P.; Steain, Megan; Slobedman, Barry

    2015-01-01

    ABSTRACT Natural killer (NK) cell-deficient patients are particularly susceptible to severe infection with herpesviruses, especially varicella-zoster virus (VZV) and herpes simplex virus 1 (HSV-1). The critical role that NK cells play in controlling these infections denotes an intricate struggle for dominance between virus and NK cell antiviral immunity; however, research in this area has remained surprisingly limited. Our study addressed this absence of knowledge and found that infection with VZV was not associated with enhanced NK cell activation, suggesting that the virus uses specific mechanisms to limit NK cell activity. Analysis of viral regulation of ligands for NKG2D, a potent activating receptor ubiquitously expressed on NK cells, revealed that VZV differentially modulates expression of the NKG2D ligands MICA, ULBP2, and ULBP3 by upregulating MICA expression while reducing ULBP2 and ULBP3 expression on the surface of infected cells. Despite being closely related to VZV, infection with HSV-1 produced a remarkably different effect on NKG2D ligand expression. A significant decrease in MICA, ULBP2, and ULBP3 was observed with HSV-1 infection at a total cellular protein level, as well as on the cell surface. We also demonstrate that HSV-1 differentially regulates expression of an additional NKG2D ligand, ULBP1, by reducing cell surface expression while total protein levels are unchanged. Our findings illustrate both a striking point of difference between two closely related alphaherpesviruses, as well as suggest a powerful capacity for VZV and HSV-1 to evade antiviral NK cell activity through novel modulation of NKG2D ligand expression. IMPORTANCE Patients with deficiencies in NK cell function experience an extreme susceptibility to infection with herpesviruses, in particular, VZV and HSV-1. Despite this striking correlation, research into understanding how these two alphaherpesviruses interact with NK cells is surprisingly limited. Through examination of viral

  1. Varicella Zoster Virus Myelitis in Two Elderly Patients: Diagnostic Value of Nested Polymerase Chain Reaction Assay and Antibody Index for Cerebrospinal Fluid Specimens

    PubMed Central

    Takahashi, Teruyuki; Tamura, Masato; Miki, Kenji; Yamaguchi, Mai; Kanno, Akira; Nunomura, Satoshi; Ra, Chisei; Tamiya, Takashi; Kamei, Satoshi; Takasu, Toshiaki

    2013-01-01

    Background Myelitis is one of the rarest neurological complications of the varicella zoster virus (VZV) infection. Focal muscle weakness with or without sensory disturbance occurs in approximately 5% of the cases after acute VZV infection, with complete recovery in 50–70%. Case Presentation This report describes two rare cases of elderly patients with VZV myelitis secondary to dermatomal zoster rash. Patient 1 was a 79-year-old woman who developed paraplegia, numbness and decreased sensation in the left arm and below thoracic (Th)-10 after sacral zoster. Spinal cord MRI showed a high-signal-intensity lesion at the cervical spinal nerve 2 on a T2-weighted image. Patient 2 was a 73-year-old man who developed right flaccid leg weakness and urinary retention after right dorsal Th 5–8 zoster. Spinal cord MRI showed a high-signal-intensity lesion at Th 3–4 on a T2-weighted image. In both cases, although the conventional single polymerase chain reaction (PCR) assays all showed negative results, the original nested PCR assay detected VZV DNA in the cerebrospinal fluid (CSF) specimen collected on admission. In addition, the anti-VZV IgG antibody by enzyme immunoassay and antibody index were elevated in the CSF specimens during the clinical courses of both patients. On the basis of these findings, both patients were diagnosed with VZV myelitis and were treated with high-dose acyclovir and corticosteroid. This combined treatment was appropriate and effective for the improvement of their functional outcomes. Conclusion The detection of VZV DNA in CSF by nested PCR assay and the evaluation of the antibody index to VZV had significant diagnostic value. PMID:23687496

  2. Reciprocal effects of varicella-zoster virus (VZV) and AP1: activation of jun, fos and ATF-2 after VZV infection and their importance for the regulation of viral genes.

    PubMed

    Rahaus, Markus; Wolff, Manfred H

    2003-03-01

    Varicella-zoster virus, an alpha-herpesvirus that is pathogenic for man, encodes its own transcription activators, but ubiquitous cellular transcription factors are of great importance, too. Performing quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) we found an increase of transcription of AP1 components jun, fos and of ATF-2 at different times post infection (p.i.). Jun and ATF-2 proteins were detected in infected cells. To study general effects of AP1 in the regulation of VZV encoded genes, oligonucleotide transfections were performed to knockout jun and ATF-2 transcription followed by infection with cell free VZV. RT-PCR analyses of ORFs 4, 9, 21, 29 and 68 belonging to all three kinetic classes of genes and containing different combinations of AP1/TRE and ATF/CREB sites in their respective promoters were carried out. In all cases a reduction of viral transcription was found. Virions produced after this procedure were still infectious, but the amount of newly synthesized virions was clearly reduced. PMID:12606072

  3. Signal transducer and activator of transcription 3 (STAT3) and survivin induction by varicella-zoster virus promote replication and skin pathogenesis.

    PubMed

    Sen, Nandini; Che, Xibing; Rajamani, Jaya; Zerboni, Leigh; Sung, Phillip; Ptacek, Jason; Arvin, Ann M

    2012-01-10

    Varicella-zoster virus (VZV) is a human α-herpesvirus that causes varicella (chickenpox) during primary infection and zoster (shingles) upon reactivation. Like other viruses, VZV must subvert the intrinsic antiviral defenses of differentiated human cells to produce progeny virions. Accordingly, VZV inhibits the activation of the cellular transcription factors IFN regulatory factor 3 (IRF3) and signal transducers and activators of transcription 1 (STAT1), thereby downregulating antiviral factors, including IFNs. Conversely, in this study, we found that VZV triggers STAT3 phosphorylation in cells infected in vitro and in human skin xenografts in SCID mice in vivo and that STAT3 activation induces the anti-apoptotic protein survivin. Small-molecule inhibitors of STAT3 phosphorylation and survivin restrict VZV replication in vitro, and VZV infection of skin xenografts in vivo is markedly impaired by the administration of the phospho-STAT3 inhibitor S3I-201. STAT3 and survivin are required for malignant transformation caused by γ-herpesviruses, such as Kaposi's sarcoma virus. We show that STAT3 activation is also critical for VZV, a nononcogenic herpesvirus, via a survivin-dependent mechanism. Furthermore, STAT3 activation is critical for the life cycle of the virus because VZV skin infection is necessary for viral transmission and persistence in the human population. Therefore, we conclude that takeover of this major cell-signaling pathway is necessary, independent of cell transformation, for herpesvirus pathogenesis and that STAT3 activation and up-regulation of survivin is a common mechanism important for the pathogenesis of lytic as well as tumorigenic herpesviruses. PMID:22190485

  4. High-Level Cellular and Humoral Immune Responses in Guinea Pigs Immunized Intradermally with a Heat-Inactivated Varicella-Zoster Virus Vaccine

    PubMed Central

    Sarkadi, Julia; Jankovics, Mate; Fodor, Kinga; Kis, Zoltan; Takacs, Maria; Visontai, Ildiko; Jankovics, Istvan

    2015-01-01

    The threat of varicella and herpes zoster in immunocompromised individuals necessitates the development of a safe and effective varicella-zoster virus (VZV) vaccine. The immune responses of guinea pigs to the intradermal (i.d.) or subcutaneous (s.c.) administration of a heat-inactivated or live VZV vaccine were investigated. Relative to nonimmunized animals, a single 399-PFU dose of vaccine induced nonsignificant increases in gamma interferon (IFN-γ), granzyme B, and perforin mRNA expression in the splenocytes of all groups, while two i.d. administrations of the inactivated vaccine increased IFN-γ mRNA expression significantly (P < 0.005). A single 1,995-PFU dose significantly increased the expression of IFN-γ mRNA in the groups receiving the vaccine either i.d. (P < 0.005) or s.c. (P < 0.05), that of granzyme B mRNA in the groups immunized i.d. with the inactivated (P < 0.005) or live (P < 0.005) vaccine, and that of perforin mRNA in the animals that received the inactivated vaccine i.d. (P < 0.005). Importantly, increases in the expression of IFN-γ (P = 0.025), granzyme B (P = 0.004), and perforin (P > 0.05) mRNAs were observed in the animals immunized i.d. with 1,995 PFU of inactivated vaccine relative to those immunized s.c. with the same dose. The proportion of animals expressing IFN-γ mRNA mirrored the proportion expressing IFN-γ protein (correlation coefficient of 0.88). VZV glycoprotein-specific and virus-neutralizing antibodies were produced with no significant intergroup differences. A booster i.d. administration of the 399-PFU dose of heat-inactivated vaccine enhanced the antibody responses. These results demonstrate that i.d. administration of an inactivated VZV vaccine can be an efficient mode of immunization against VZV. PMID:25787138

  5. A phase 1/2 study of an adjuvanted varicella-zoster virus subunit vaccine in autologous hematopoietic cell transplant recipients

    PubMed Central

    Sullivan, Keith M.; Marty, Francisco M.; Dadwal, Sanjeet S.; Papanicolaou, Genovefa A.; Shea, Thomas C.; Mossad, Sherif B.; Andreadis, Charalambos; Young, Jo-Anne H.; Buadi, Francis K.; El Idrissi, Mohamed; Heineman, Thomas C.; Berkowitz, Elchonon M.

    2014-01-01

    Recombinant herpes zoster (HZ) vaccines may be an alternative to the live-attenuated HZ vaccine for immunocompromised individuals. This was a phase 1/2, randomized, observer-blind, placebo-controlled study in adults with multiple myeloma, non-Hodgkin lymphoma (B- or T-cell), Hodgkin lymphoma, or acute myeloid leukemia who had undergone autologous hematopoietic stem-cell transplant 50 to 70 days earlier. Subjects (N = 121) were randomized 1:1:1:1 to receive (at months 0, 1, 3) three doses of 50 μg varicella-zoster virus glycoprotein E (gE) adjuvanted with AS01B, 3 doses of gE adjuvanted with AS01E, 1 dose of saline followed by 2 doses of gE/AS01B, or 3 doses of saline. One month after the last dose (6 months after transplant), frequencies of CD4+ T cells expressing ≥2 activation markers after induction with gE and anti-gE antibody concentrations were higher with all gE/AS01 regimens than with saline. Both responses persisted up to 1 year in subjects vaccinated with gE/AS01. Immune responses were higher in the gE/AS01B 3-dose group than in the gE/AS01B 2-dose group but not higher than in the gE/AS01E 3-dose group. One serious adverse event (pneumonia) was considered vaccine related. Both formulations and both schedules were immunogenic and well tolerated in this population. This study was registered at www.clinicaltrials.gov as #NCT00920218. PMID:25237196

  6. A phase 1/2 study of an adjuvanted varicella-zoster virus subunit vaccine in autologous hematopoietic cell transplant recipients.

    PubMed

    Stadtmauer, Edward A; Sullivan, Keith M; Marty, Francisco M; Dadwal, Sanjeet S; Papanicolaou, Genovefa A; Shea, Thomas C; Mossad, Sherif B; Andreadis, Charalambos; Young, Jo-Anne H; Buadi, Francis K; El Idrissi, Mohamed; Heineman, Thomas C; Berkowitz, Elchonon M

    2014-11-01

    Recombinant herpes zoster (HZ) vaccines may be an alternative to the live-attenuated HZ vaccine for immunocompromised individuals. This was a phase 1/2, randomized, observer-blind, placebo-controlled study in adults with multiple myeloma, non-Hodgkin lymphoma (B- or T-cell), Hodgkin lymphoma, or acute myeloid leukemia who had undergone autologous hematopoietic stem-cell transplant 50 to 70 days earlier. Subjects (N = 121) were randomized 1:1:1:1 to receive (at months 0, 1, 3) three doses of 50 μg varicella-zoster virus glycoprotein E (gE) adjuvanted with AS01B, 3 doses of gE adjuvanted with AS01E, 1 dose of saline followed by 2 doses of gE/AS01B, or 3 doses of saline. One month after the last dose (6 months after transplant), frequencies of CD4(+) T cells expressing ≥2 activation markers after induction with gE and anti-gE antibody concentrations were higher with all gE/AS01 regimens than with saline. Both responses persisted up to 1 year in subjects vaccinated with gE/AS01. Immune responses were higher in the gE/AS01B 3-dose group than in the gE/AS01B 2-dose group but not higher than in the gE/AS01E 3-dose group. One serious adverse event (pneumonia) was considered vaccine related. Both formulations and both schedules were immunogenic and well tolerated in this population. This study was registered at www.clinicaltrials.gov as #NCT00920218. PMID:25237196

  7. Rapid automation of a cell-based assay using a modular approach: case study of a flow-based Varicella Zoster Virus infectivity assay.

    PubMed

    Joelsson, Daniel; Gates, Irina V; Pacchione, Diana; Wang, Christopher J; Bennett, Philip S; Zhang, Yuhua; McMackin, Jennifer; Frey, Tina; Brodbeck, Kristin C; Baxter, Heather; Barmat, Scott L; Benetti, Luca; Bodmer, Jean-Luc

    2010-06-01

    Vaccine manufacturing requires constant analytical monitoring to ensure reliable quality and a consistent safety profile of the final product. Concentration and bioactivity of active components of the vaccine are key attributes routinely evaluated throughout the manufacturing cycle and for product release and dosage. In the case of live attenuated virus vaccines, bioactivity is traditionally measured in vitro by infection of susceptible cells with the vaccine followed by quantification of virus replication, cytopathology or expression of viral markers. These assays are typically multi-day procedures that require trained technicians and constant attention. Considering the need for high volumes of testing, automation and streamlining of these assays is highly desirable. In this study, the automation and streamlining of a complex infectivity assay for Varicella Zoster Virus (VZV) containing test articles is presented. The automation procedure was completed using existing liquid handling infrastructure in a modular fashion, limiting custom-designed elements to a minimum to facilitate transposition. In addition, cellular senescence data provided an optimal population doubling range for long term, reliable assay operation at high throughput. The results presented in this study demonstrate a successful automation paradigm resulting in an eightfold increase in throughput while maintaining assay performance characteristics comparable to the original assay. PMID:20117140

  8. Fulminant visceral disseminated varicella-zoster virus infection without skin involvement in a patient with autoimmune hemolytic anemia on prednisolone therapy.

    PubMed

    Akiyama, Megumi; Yoshifuji, Kota; Fukuda, Tetsuya; Tohda, Shuji; Miki, Tohru; Miura, Osamu; Yamamoto, Masahide

    2016-04-01

    An 80-year-old man with autoimmune hemolytic anemia (AIHA) received immunosuppressive therapy with prednisolone (1 mg/kg). One month later, his hemoglobin level had normalized, and the prednisolone dose was tapered. The next day, he complained of acute and progressive back pain. He was admitted to our hospital for further examination approximately 24 h after the pain had started. Computed tomography revealed only localized pneumonia. However, he showed signs of severe disseminated intravascular coagulation (DIC), liver dysfunction, and respiratory failure. Empiric broad-spectrum antibacterial therapy was started with a presumptive diagnosis of severe bacterial infection. However, his condition rapidly deteriorated, and he died 17 h after admission. Varicella-zoster virus (VZV) was detected by quantitative PCR in the peripheral blood sample and by immunohistochemistry in all organs except for the brain at autopsy. Visceral VZV infection is a severe disease with a high mortality rate. Although appropriate diagnosis and treatment is crucial, in cases without the characteristic skin rash the diagnosis is difficult. The possibility of visceral VZV infection should be taken into consideration when administering prednisolone to patients with AIHA. PMID:27169452

  9. Varicella-Zoster Virus and Herpes Simplex Virus 1 Can Infect and Replicate in the Same Neurons whether Co- or Superinfected

    PubMed Central

    Sloutskin, Anna; Yee, Michael B.; Kinchington, Paul R.

    2014-01-01

    ABSTRACT The two human neurotropic alphaherpesviruses varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV1) both establish latency in sensory ganglia. Human trigeminal ganglia are known to frequently harbor both viruses, and there is evidence to suggest the presence of both VZV and HSV1 DNA in the same neuron. We ask here whether VZV and HSV1 can exclude themselves and each other and whether they can productively infect the same cells in human neurons and human foreskin fibroblasts (HFF). Simultaneous infection (coinfection) or consecutive infection (superinfection) was assessed using cell-free HSV1 and VZV expressing fluorescent reporter proteins. Automated analysis was carried out to detect singly and dually infected cells. We demonstrate that VZV and HSV1 both display efficient superinfection exclusion (SE) in HFF, with each virus excluding either itself or the other virus. While SE also occurred in neurons, it was with much lower efficiency. Both alphaherpesviruses productively infected the same neurons, whether applied simultaneously or even consecutively, albeit at lower frequencies. IMPORTANCE Superinfection exclusion by VZV for itself or the related neurotropic alphaherpesvirus HSV1 has been studied here for the first time. We find that while these viruses display classic SE in fibroblasts, SE is less efficient for both HSV1 and VZV in human neurons. The ability of multiple VZV strains to productively infect the same neurons has important implications in terms of recombination of both wild-type and vaccine strains in patients. PMID:24574392

  10. The High Prevalence of the Varicella Zoster Virus in Patients With Relapsing-Remitting Multiple Sclerosis: A Case-Control Study in the North of Iran

    PubMed Central

    Najafi, Saeideh; Ghane, Masood; Yousefzadeh-Chabok, Shahrokh; Amiri, Mehdi

    2016-01-01

    Background Multiple sclerosis (MS) is the most common neurological autoimmune disease, characterized by multifocal areas of inflammatory demyelination within the central nervous system. It has been hypothesized that the stimulation of the immune system by viral infections is the leading cause of MS among susceptible individuals. Objectives The aim of this study was to investigate the prevalence of the varicella zoster virus (VZV) in patients with relapsing-remitting multiple sclerosis. Patients and Methods Plasma and peripheral blood mononuclear cells (PBMCs) collected from MS patients (n = 82) and controls (n = 89) were screened for the presence of anti-VZV antibodies and VZV DNA by the ELISA and PCR methods. DNA was extracted from all samples, and VZV infection was examined by the PCR technique. Statistical analysis was used to investigate the frequency of the virus in MS patients and a healthy control group. Results Of all the MS patients, 78 (95.1%) and 21 (25.6%) were positive for anti-VZV and VZV DNA, respectively. Statistical analysis of the PCR results showed a significant correlation between the abundance of VZV and MS disease (P < 0.001). However, there was no significant correlation between the abundance of anti-VZV antibodies and MS disease by the ELISA method. Conclusions These results support the hypothesis that VZV may contribute to MS in establishing a systemic infection process and inducing an immune response. PMID:27226879

  11. Detection of Vero Cells Infected with Herpes Simplex Types 1 and 2 and Varicella Zoster Viruses Using Raman Spectroscopy and Advanced Statistical Methods

    PubMed Central

    Huleihel, Mahmoud; Shufan, Elad; Zeiri, Leila; Salman, Ahmad

    2016-01-01

    Of the eight members of the herpes family of viruses, HSV1, HSV2, and varicella zoster are the most common and are mainly involved in cutaneous disorders. These viruses usually are not life-threatening, but in some cases they might cause serious infections to the eyes and the brain that can lead to blindness and possibly death. An effective drug (acyclovir and its derivatives) is available against these viruses. Therefore, early detection and identification of these viral infections is highly important for an effective treatment. Raman spectroscopy, which has been widely used in the past years in medicine and biology, was used as a powerful spectroscopic tool for the detection and identification of these viral infections in cell culture, due to its sensitivity, rapidity and reliability. Our results showed that it was possible to differentiate, with a 97% identification success rate, the uninfected Vero cells that served as a control, from the Vero cells that were infected with HSV-1, HSV-2, and VZV. For that, linear discriminant analysis (LDA) was performed on the Raman spectra after principal component analysis (PCA) with a leave one out (LOO) approach. Raman spectroscopy in tandem with PCA and LDA enable to differentiate among the different herpes viral infections of Vero cells in time span of few minutes with high accuracy rate. Understanding cell molecular changes due to herpes viral infections using Raman spectroscopy may help in early detection and effective treatment. PMID:27078266

  12. Varicella-Zoster Virus Infects Human Embryonic Stem Cell-Derived Neurons and Neurospheres but Not Pluripotent Embryonic Stem Cells or Early Progenitors

    PubMed Central

    Dukhovny, Anna; Sloutskin, Anna; Markus, Amos; Yee, Michael B.; Kinchington, Paul R.

    2012-01-01

    Pluripotent human stem cells are a powerful tool for the generation of differentiated cells that can be used for the study of human disease. We recently demonstrated that neurons derived from pluripotent human embryonic stem cells (hESC) can be infected by the highly host-restricted human alphaherpesvirus varicella-zoster virus (VZV), permitting the interaction of VZV with neurons to be readily evaluated in culture. In the present study, we examine whether pluripotent hESC and neural progenitors at intermediate stages of differentiation are permissive for VZV infection. We demonstrate here that VZV infection is blocked in naïve hESC. A block to VZV replication is also seen when a bacterial artificial chromosome (BAC) containing the VZV genome is transfected into hESC. In contrast, related alphaherpesviruses herpes simplex virus 1 (HSV-1) and pseudorabies virus (PrV) productively infect naïve hESC in a cell-free manner, and PrV replicates from a BAC transfected into hESC. Neurons differentiate from hESC via neural progenitor intermediates, as is the case in the embryo. The first in vitro stage at which permissiveness of hESC-derived neural precursors to VZV replication is observed is upon formation of “neurospheres,” immediately after detachment from the inductive stromal feeder layer. These findings suggest that hESC may be useful in deciphering the yet enigmatic mechanisms of specificity of VZV infection and replication. PMID:22238301

  13. Hemorrhagic Pericarditis in a child with primary varicella infection (chickenpox).

    PubMed

    Nandeesh, B N; Mahadevan, Anita; Yasha, T C; Shankar, S K

    2009-01-01

    Chickenpox (Varicella) representing the primary infection by Varicella zoster virus is a common benign and self-limited infectious disease of childhood. Although the disease can be associated with complications, they are generally mild and tend to occur in adults and immunocompromised children. Severe and life-threatening complications are extremely rare, particularly those involving the cardiovascular system. We report a malnourished 5-year-old girl with chicken pox complicated by hemorrhagic pericarditis and deep vein thrombosis leading to fatal pulmonary thromboembolism. Though varicella infection runs a benign self-limiting course, it continues to cause significant morbidity and mortality when associated with complications, particularly in malnourished children. Hence, the importance of vaccination and early recognition of complications is emphasized. PMID:19332925

  14. Three-Dimensional Normal Human Neutral Progenitor Tissue-Like Assemblies: A Model for Persistent Varicella-Zoster Virus Infection and Platform to Study Oxidate Stress and Damage in Multiple Hit Scenarios

    NASA Technical Reports Server (NTRS)

    Goodwin, Thomas J.; McCarthy, M.; Osterrieder, N.; Cohrs, R. J.; Kaufer, B. B.

    2014-01-01

    The environment of space results in a multitude of challenges to the human physiology that present barriers to extended habitation and exploration. Over 40 years of investigation to define countermeasures to address space flight adaptation has left gaps in our knowledge regarding mitigation strategies partly due to the lack of investigative tools, monitoring strategies, and real time diagnostics to understand the central causative agent(s) responsible for physiologic adaptation and maintaining homeostasis. Spaceflight-adaptation syndrome is the combination of space environmental conditions and the synergistic reaction of the human physiology. Our work addresses the role of oxidative stress and damage (OSaD) as a negative and contributing Risk Factor (RF) in the following areas of combined spaceflight related dysregulation: i) radiation induced cellular damage [1], [2] ii) immune impacts and the inflammatory response [3], [4] and iii) varicella zoster virus (VZV) reactivation [5]. Varicella-zoster (VZV)/Chicken Pox virus is a neurotropic human alphaherpes virus resulting in varicella upon primary infection, suppressed by the immune system becomes latent in ganglionic neurons, and reactivates under stress events to re-express in zoster and possibly shingles. Our laboratory has developed a complex three-dimensional (3D) normal human neural tissue model that emulates several characteristics of the human trigeminal ganglia (TG) and allows the study of combinatorial experimentation which addresses, simultaneously, OSaD associated with Spaceflight adaptation and habitation [6]. By combining the RFs of microgravity, radiation, and viral infection we will demonstrate that living in the space environment leads to significant physiological consequences for the peripheral and subsequently the central nervous system (PNS, CNS) associated with OSaD generation and consequentially endangers long-duration and exploration-class missions.

  15. Herpes zoster in children.

    PubMed

    Peterson, Nathan; Goodman, Seth; Peterson, Michael; Peterson, Warren

    2016-08-01

    Herpes zoster (HZ) in immunocompetent children is quite uncommon. Initial exposure to the varicella-zoster virus (VZV) may be from a wild-type or vaccine-related strain. Either strain may cause a latent infection and subsequent eruption of HZ. We present a case of HZ in a 15-month-old boy after receiving the varicella vaccination at 12 months of age. A review of the literature regarding the incidence, clinical characteristics, and diagnosis of HZ in children also is provided. PMID:27622252

  16. Herpes zoster ophthalmicus in an otherwise-healthy child.

    PubMed

    Binder, Nicholas R; Holland, Gary N; Hosea, Stephen; Silverberg, Mark L

    2005-12-01

    Herpes zoster ophthalmicus, although not uncommon in adults, is rarely found in children. Herein we present a case of pediatric herpes zoster ophthalmicus that is unique in 2 ways. First, the child had been vaccinated against varicella and otherwise had no known exposure to varicella-zoster virus. Second, the initial presentation of herpes zoster ophthalmicus was a painful and diffuse subconjunctival hemorrhage that appeared before any of its classic signs were observed. We report this case to document the possible occurrence of herpes zoster ophthalmicus in children who have been vaccinated against varicella and the possibility of a diffuse, painful subconjunctival hemorrhage as a presenting sign. PMID:16414532

  17. Impact of the duration of antiviral prophylaxis on rates of varicella-zoster virus reactivation disease in autologous hematopoietic cell transplantation recipients.

    PubMed

    Truong, Quoc; Veltri, Lauren; Kanate, Abraham S; Hu, Yanqing; Craig, Michael; Hamadani, Mehdi; Cumpston, Aaron

    2014-04-01

    Varicella-zoster virus (VZV) reactivation is a relatively common cause of morbidity following autologous hematopoietic cell transplant (auto-HCT). The Centers for Disease Control in 2009 recommended extending VZV prophylaxis for 1 year post-transplantation. We retrospectively analyzed rates of VZV reactivation following auto-HCT at our transplant center prior to and after the implementation of extended antiviral prophylaxis in June 2008. The study population was divided into three different cohorts according to the length of VZV prophylaxis as following: (1) prophylaxis until neutrophil recovery to ≥500/μL (n = 77), (2) prophylaxis for 6 months (n = 12), or (3) 12 months (n = 40) post-auto-HCT. All patients received acyclovir 400 mg oral or intravenously twice daily or valacyclovir 500 mg oral daily. For patients in whom VZV reactivation occurred, data was collected on severity of infection, time of onset, treatment, and any associated complications. One hundred twenty-nine patients undergoing auto-HCT between January 1, 2004 and January 31, 2010 were included in the study. There was a significant difference in the rates of VZV reactivation between the neutrophil recovery and 12 months prophylaxis cohorts at 14 % (n = 11) and 2 % (n = 1) (P = 0.04), respectively. VZV reactivation rate in the 6-month prophylaxis group was 17 % (n = 2), but did not reach statistical significance due to small numbers. In the subset of auto-HCT patients treated with bortezomib, 13 % (n = 2) developed VZV reactivation in the neutrophil recovery group, while no events occurred in the other two cohorts. Complications of VZV reactivation include post-herpetic neuralgia (n = 5), severe pain (n = 3), scarring (n = 1), and motor weakness (n = 1); two patients required hospitalization and three patients developed disseminated zoster. Our limited retrospective analysis suggests a significant reduction in rates of post-auto-HCT rates of VZV

  18. Vaccination to prevent varicella

    PubMed Central

    King, PG

    2014-01-01

    Background: There is increasing evidence that herpes zoster (HZ) incidence rates among children and adults (aged <60 years) with a history of natural varicella are influenced primarily by the frequency of exogenous exposures, while asymptomatic endogenous reactivations help to cap the rate at approximately 550 cases/100,000 person-years when exogenous boosting becomes rare. The Antelope Valley Varicella Active Surveillance Project was funded by the Centers for Disease Control and Prevention in 1995 to monitor the effects of varicella vaccination in one of the three representative regions of the United States. The stability in the data collection and number of reporting sites under varicella surveillance from 1995–2002 and HZ surveillance during 2000–2001 and 2006–2007 contributed to the robustness of the discerned trends. Discussion: Varicella vaccination may be useful for leukemic children; however, the target population in the United States is all children. Since the varicella vaccine inoculates its recipients with live, attenuated varicella–zoster virus (VZV), clinical varicella cases have dramatically declined. Declining exogenous exposures (boosts) from children shedding natural VZV have caused waning cell-mediated immunity. Thus, the protection provided by varicella vaccination is neither lifelong nor complete. Moreover, dramatic increases in the incidence of adult shingles cases have been observed since HZ was added to the surveillance in 2000. In 2013, this topic is still debated and remains controversial in the United States. Summary: When the costs of the booster dose for varicella and the increased shingles recurrences are included, the universal varicella vaccination program is neither effective nor cost-effective. PMID:24275643

  19. Genetic Analysis of Varicella-Zoster Virus ORF0 to ORF4 by Use of a Novel Luciferase Bacterial Artificial Chromosome System▿

    PubMed Central

    Zhang, Zhen; Rowe, Jenny; Wang, Weijia; Sommer, Marvin; Arvin, Ann; Moffat, Jennifer; Zhu, Hua

    2007-01-01

    To efficiently generate varicella-zoster virus (VZV) mutants, we inserted a bacterial artificial chromosome (BAC) vector in the pOka genome. We showed that the recombinant VZV (VZVBAC) strain was produced efficiently from the BAC DNA and behaved indistinguishably from wild-type virus. Moreover, VZV's cell-associated nature makes characterizing VZV mutant growth kinetics difficult, especially when attempts are made to monitor viral replication in vivo. To overcome this problem, we then created a VZV strain carrying the luciferase gene (VZVLuc). This virus grew like the wild-type virus, and the resulting luciferase activity could be quantified both in vitro and in vivo. Using PCR-based mutagenesis, open reading frames (ORF) 0 to 4 were individually deleted from VZVLuc genomes. The deletion mutant viruses appeared after transfection into MeWo cells, except for ORF4, which was essential. Growth curve analysis using MeWo cells and SCID-hu mice indicated that ORF1, ORF2, and ORF3 were dispensable for VZV replication both in vitro and in vivo. Interestingly, the ORF0 deletion virus showed severely retarded growth both in vitro and in vivo. The growth defects of the ORF0 and ORF4 mutants could be fully rescued by introducing wild-type copies of these genes back into their native genome loci. This work has validated and justified the use of the novel luciferase VZV BAC system to efficiently generate recombinant VZV variants and ease subsequent viral growth kinetic analysis both in vitro and in vivo. PMID:17581997

  20. Regulation of Varicella-Zoster Virus-Induced Cell-to-Cell Fusion by the Endocytosis-Competent Glycoproteins gH and gE

    PubMed Central

    Pasieka, Tracy Jo; Maresova, Lucie; Shiraki, Kimiyasu; Grose, Charles

    2004-01-01

    The gH glycoprotein of varicella-zoster virus (VZV) is a major fusogen. The realigned short cytoplasmic tail of gH (18 amino acids) harbors a functional endocytosis motif (YNKI) that mediates internalization in both VZV-infected and transfected cells (T. J. Pasieka, L. Maresova, and C. Grose, J. Virol. 77: 4194-4202, 2003). During subsequent confocal microscopy studies of endocytosis-deficient gH mutants, we observed that cells transfected with the gH tail mutants exhibited marked fusion. Therefore, we postulated that VZV gH endocytosis served to regulate cell-to-cell fusion. Subsequent analyses of gH+gL transfection fusion assays by the Kolmogorov-Smirnov statistical test demonstrated that expression of the endocytosis-deficient gH mutants resulted in a statistically significant enhancement of cell-to-cell fusion (P < 0.0001) compared to wild-type gH. On the other hand, coexpression of VZV gE, another endocytosis-competent VZV glycoprotein, was able to temper the fusogenicity of the gH endocytosis mutants by facilitating internalization of the mutant gH protein from the cell surface. When the latter results were similarly analyzed, there was no longer any enhanced fusion by the endocytosis-deficient gH mutant protein. In summary, these studies support a role for gH endocytosis in regulating the cell surface expression of gH and thereby regulating gH-mediated fusion. The data also confirm and extend prior observations of a gE-gH interaction during viral glycoprotein trafficking in a VZV transfection system. PMID:14990707

  1. Varicella-zoster virus p32/p36 complex is present in both the viral capsid and the nuclear matrix of the infected cell.

    PubMed Central

    Friedrichs, W E; Grose, C

    1986-01-01

    Varicella-zoster virus (VZV) directs the synthesis of numerous glycosylated and nonglycosylated infected-cell-specific proteins, many of which are later incorporated into the virion as structural components. In this study, we characterized a nonglycosylated polypeptide complex with the aid of a VZV-specific murine monoclonal antibody clone, 251D9. As detected by indirect immunofluorescence, the antibody bound mainly to antigens located within the nuclei of infected cells and did not attach to an uninfected cell substrate. The polypeptide specificity of the monoclonal antibody was determined by immunoblot analysis of electrophoretically separated infected cell extracts to react with a 32,000-molecular-weight VZV-specific protein (p32); in addition, the antibody also bound to a 36,000-molecular-weight polypeptide. The synthesis of these antigens was unaffected by inhibitors of glycosylation. Nonionic or ionic detergents were only marginally effective in solubilization of the p32-p36 complex, and relatively small amounts were eluted from nuclei by high salt concentrations (2 M NaCl). The same proteins remained associated with the nuclear matrix of VZV-infected cells. We also demonstrated that the protein complex was a major component of purified VZV nucleocapsids; p32 was especially prominent in both full and empty capsids. Immunoblot analysis of the nucleocapsid preparation revealed two additional species (p34 and p38) in the p32-p36 complex. Phosphorylation was a distinctive feature of some of the constituents. In summary, these results indicate that the p32-p36 complex represents a family of structural proteins closely associated with the assembly of VZV nucleocapsids and the encapsidation of viral DNA. Images PMID:3001341

  2. A Rapid Phenotypic Assay for Detection of Acyclovir-Resistant Varicella-Zoster Virus with Mutations in the Thymidine Kinase Open Reading Frame

    PubMed Central

    Sahli, Roland; Andrei, Graciela; Estrade, Christine; Snoeck, Robert; Meylan, Pascal R. A.

    2000-01-01

    Susceptibility assays by cell culture methods are time-consuming and are particularly difficult to perform with varicella-zoster virus (VZV). To overcome this limitation, we have adapted a functional test of the viral thymidine kinase (TK) in TK-deficient (tdk mutant) bacteria to detect ACV-resistant VZV in clinical samples. After PCR amplification, the complete viral TK open reading frame (ORF) is purified from PCR primers, digested with two restriction enzymes, and ligated in an oriented fashion into a bacterial expression vector. The ligation products are then used to transform tdk mutant bacteria. After transformation, an aliquot of the bacteria is plated onto a plate with minimal medium containing (i) ampicillin to select for plasmids carrying the viral TK ORF and (ii) isopropyl β-d-thiogalactopyranoside (IPTG) to induce its expression. An identical aliquot of bacteria is also plated onto a medium containing, in addition to the components described above, 5-fluorodeoxyuridine (FUdR). Compared to the number of transformants on FUdR-free medium, the number of colonies carrying TK derived from susceptible strains was reduced by 86%, on average, in the presence of FUdR. In contrast, the number of transformants carrying TK from resistant strains with a mutant TK were reduced by only 4%, on average, on FUdR-containing plates. We have assessed the validity of this assay with cell culture isolates and several clinical samples including two cerebrospinal fluid samples from which no virus could be isolated. This colony reduction assay allowed the correct identification of the TK phenotype of each VZV isolate tested and can be completed within 3 days of receipt of the sample. PMID:10722484

  3. Time Profile of Viral DNA in Aqueous Humor Samples of Patients Treated for Varicella-Zoster Virus Acute Retinal Necrosis by Use of Quantitative Real-Time PCR

    PubMed Central

    Bernheim, D.; Germi, R.; Labetoulle, M.; Romanet, J. P.; Morand, P.

    2013-01-01

    The objective of this study was to evaluate the kinetics of varicella-zoster virus (VZV) loads using quantitative PCR (qPCR) in patients treated for acute retinal necrosis (ARN). Six patients (52 ± 13 years old) with ARN syndrome were consecutively studied. Aqueous humor (AH) was sampled from both eyes of all patients for qPCR evaluation. The patients were treated with intravenous acyclovir and intravitreal injections of antiviral drugs. The mean follow-up time was 17.6 ± 16.4 months. Main outcome measures were the numbers of viral genome copies in the AH, assessed using real-time qPCR with hydrolysis probe technology with a threshold of detection of 200 copies/ml. Two main portions of the viral load curves were observed for each patient: a plateau phase (27.8 ± 24.9 days) and a decrease in the number of viral genome copies. The mean baseline viral load was 3.4 × 107 ± 4.45 × 107 copies/ml (6 × 106 to 1.2 × 108 copies/ml). The viral load decreased according to a logarithmic model, with a 50% reduction obtained in 3 ± 0.7 days. There was a significant viral load (>102 copies/ml) at 50 days after the onset of treatment, despite antiviral drugs. qPCR use demonstrated reproducible VZV DNA kinetics with a two-phase evolution: a plateau followed by a logarithmic decrease. These data suggest that high-dosage antiviral therapy administered for the conventional 10-day duration is insufficient for most patients. This series of patients responded with a similar decrease in viral load once treatment was initiated, and the data from these patients may be used to predict the responses of future patients. PMID:23637296

  4. Use of lambdagt11 to isolate genes for two pseudorabies virus glycoproteins with homology to herpes simplex virus and varicella-zoster virus glycoproteins

    SciTech Connect

    Petrovskis, E.A.; Timmins, J.G.; Post, L.E.

    1986-10-01

    A library of pseudorabies virus (PRV) DNA fragments was constructed in the expression cloning vector lambdagt11. The library was screened with antisera which reacted with mixtures of PRV proteins to isolate recombinant bacteriophages expressing PRV proteins. By the nature of the lambdagt11 vector, the cloned proteins were expressed in Escherichia coli as ..beta..-galactosidase fusion proteins. The fusion proteins from 35 of these phages were purified and injected into mice to raise antisera. The antisera were screened by several different assays, including immunoprecipitation of (/sup 14/C)glucosamine-labeled PRV proteins. This method identified phages expressing three different PRV glycoproteins: the secreted glycoprotein, gX; gI; and a glycoprotein that had not been previously identified, which we designate gp63. The gp63 and gI genes map adjacent to each other in the small unique region of the PRV genome. The DNA sequence was determined for the region of the genome encoding gp63 and gI. It was found that gp63 has a region of homology with a herpes simplex virus type 1 (HSV-1) protein, encoded by US7, and also with varicella-zoster virus (VZV) gpIV. The gI protein sequence has a region of homology with HSV-1 gE and VZV gpI. It is concluded that PRV, HSV, and VZV all have a cluster of homologous glycoprotein genes in the small unique components of their genomes and that the organization of these genes is conserved.

  5. Immunization with recombinant varicella-zoster virus expressing herpes simplex virus type 2 glycoprotein D reduces the severity of genital herpes in guinea pigs.

    PubMed Central

    Heineman, T C; Connelly, B L; Bourne, N; Stanberry, L R; Cohen, J

    1995-01-01

    Varicella-zoster virus (VZV) is an attractive candidate for a live-virus vector for the delivery of foreign antigens. The Oka vaccine strain of VZV is safe and effective in humans, and recombinant Oka VZV (ROka) can be generated by transfecting cells with a set of overlapping cosmid DNAs. By this method, the herpes simplex virus type 2 (HSV-2) glycoprotein D (gD2) gene was inserted into an intergenic site in the unique short region of the Oka VZV genome. Expression of gD2 in cells infected with the recombinant Oka strain VZV (ROka-gD2) was confirmed by antibody staining of fixed cells and by immunoblot analysis. Immune electron microscopy demonstrated the presence of gD2 in the envelope of ROka-gD2 virions. The ability of ROka-gD2 to protect guinea pigs against HSV-2 challenge was assessed by inoculating animals with three doses of uninfected human fibroblasts, fibroblasts infected with ROka VZV, or fibroblasts infected with ROka-gD2. Neutralizing antibodies specific for HSV-2 developed in animals immunized with ROka-gD2. Forty days after the third inoculation, animals were challenged intravaginally with HSV-2. Inoculation of guinea pigs with ROka-gD2 significantly reduced the severity of primary HSV-2 infection (P < 0.001). These experiments demonstrate that the Oka strain of VZV can be used as a live virus vector to protect animals from disease with a heterologous virus. PMID:7494331

  6. Identification of the phosphorylation sequence in the cytoplasmic tail of the varicella-zoster virus Fc receptor glycoprotein gpI.

    PubMed Central

    Yao, Z; Jackson, W; Grose, C

    1993-01-01

    Varicella-zoster virus (VZV) glycoprotein gpI, the homolog of herpes simplex virus gE, functions as a receptor for the Fc portion of immunoglobulin G. Like other cell surface receptors, this viral receptor is highly phosphorylated in cell culture. To identify the precise location of the cellular kinase-mediated phosphorylation, we generated a tailless deletion mutant and several point mutants which had altered serine and threonine residues within the cytoplasmic domain of gpI. The mutated and wild-type genes of gpI were transfected and expressed within a vaccinia virus-T7 polymerase transfection system in order to determine what effect these mutations had on the phosphorylation state of the protein in vivo and in vitro. Truncation of the cytoplasmic domain of gpI diminished the phosphorylation of gpI in vivo. Examination of the point mutants established that the major phosphorylation sequence of gpI was located between amino acids 593 and 598, a site which included four phosphorylatable serine and threonine residues. Phosphorylation analyses of the mutant and wild-type glycoproteins confirmed that gpI was a substrate for casein kinase II, with threonines 596 and 598 being critical residues. Although the mutant glycoproteins were phosphorylated by casein kinase I, protease V8 partial digestion profiles suggested that casein kinase II exerted the major effect. Thus, these mutagenesis studies demonstrated that the gpI cytoplasmic sequence Ser-Glu-Ser-Thr-Asp-Thr was phosphorylated in mammalian cells in the absence of any other herpesvirus products. Since the region defined by transfection was consistent with results obtained with in vitro phosphorylation by casein kinase II, we propose that VZV gpI is a physiologic substrate for casein kinase II. Immunofluorescence and pulse-chase experiments demonstrated that the mutant glycoproteins were processed and transported to the outer cell membrane. Images PMID:8392591

  7. Time profile of viral DNA in aqueous humor samples of patients treated for varicella-zoster virus acute retinal necrosis by use of quantitative real-time PCR.

    PubMed

    Bernheim, D; Germi, R; Labetoulle, M; Romanet, J P; Morand, P; Chiquet, C

    2013-07-01

    The objective of this study was to evaluate the kinetics of varicella-zoster virus (VZV) loads using quantitative PCR (qPCR) in patients treated for acute retinal necrosis (ARN). Six patients (52 ± 13 years old) with ARN syndrome were consecutively studied. Aqueous humor (AH) was sampled from both eyes of all patients for qPCR evaluation. The patients were treated with intravenous acyclovir and intravitreal injections of antiviral drugs. The mean follow-up time was 17.6 ± 16.4 months. Main outcome measures were the numbers of viral genome copies in the AH, assessed using real-time qPCR with hydrolysis probe technology with a threshold of detection of 200 copies/ml. Two main portions of the viral load curves were observed for each patient: a plateau phase (27.8 ± 24.9 days) and a decrease in the number of viral genome copies. The mean baseline viral load was 3.4 × 10(7) ± 4.45 × 10(7) copies/ml (6 × 10(6) to 1.2 × 10(8) copies/ml). The viral load decreased according to a logarithmic model, with a 50% reduction obtained in 3 ± 0.7 days. There was a significant viral load (>102 copies/ml) at 50 days after the onset of treatment, despite antiviral drugs. qPCR use demonstrated reproducible VZV DNA kinetics with a two-phase evolution: a plateau followed by a logarithmic decrease. These data suggest that high-dosage antiviral therapy administered for the conventional 10-day duration is insufficient for most patients. This series of patients responded with a similar decrease in viral load once treatment was initiated, and the data from these patients may be used to predict the responses of future patients. PMID:23637296

  8. Varicella and Varicella Vaccination in South Korea

    PubMed Central

    Choi, Eun Hwa; Shin, Seon Hee; Kim, Yun-Kyung; Chang, Jin Keun; Choi, Kyong Min; Hur, Jae Kyun; Kim, Kyung-Hyo; Kim, Jae Youn; Chung, Eun Hee; Lee, Soo Young; Park, Su Eun; Cha, Sungho; Kim, Kwang-Nam; Ma, Sang Hyuk; Eun, Byung Wook; Kim, Nam Hee; Jo, Dae Sun; Choi, Bo Youl; Kim, Shin Ah

    2014-01-01

    With continuing occurrence of varicella despite increasing vaccine coverage for the past 20 years, a case-based study, a case-control study, and an immunogenicity and safety study were conducted to address the impact of varicella vaccination in South Korea. Varicella patients under the age of 16 years were enrolled for the case-based study. For the case-control study, varicella patients between 12 months and 15 years of age were enrolled with one control matched for each patient. For the immunogenicity and safety study, otherwise healthy children from 12 to 24 months old were immunized with Suduvax (Green Cross, South Korea). Fluorescent antibody to membrane antigen (FAMA) varicella-zoster virus (VZV) antibody was measured before and 6 weeks after immunization. In the case-based study, the median age of the patients was 4 years. Among 152 patients between 1 and 15 years of age, 139 children received varicella vaccine and all had breakthrough infections. Clinical courses were not ameliorated in vaccinated patients, but more vaccinated patients received outpatient rather than inpatient care. In the case-control study, the adjusted overall effectiveness of varicella vaccination was 54%. In the immunogenicity and safety study, the seroconversion rate and geometric mean titer for FAMA antibody were 76.67% and 5.31. Even with increasing varicella vaccine uptake, we illustrate no upward age shift in the peak incidence, a high proportion of breakthrough disease, almost no amelioration in disease presentation by vaccination, and insufficient immunogenicity of domestic varicella vaccine. There is need to improve the varicella vaccine used in South Korea. PMID:24671555

  9. Multiple regulatory effects of varicella-zoster virus (VZV) gL on trafficking patterns and fusogenic properties of VZV gH.

    PubMed Central

    Duus, K M; Grose, C

    1996-01-01

    Varicella-zoster virus (VZV) is an extremely cell-associated alphaherpesvirus; VZV infection is spread almost exclusively via cell membrane fusion. The envelope glycoprotein H (gH) is highly conserved among the herpesviruses. A virus-encoded chaperone, glycoprotein L (gL), associates with gH, and the gH:gL complex is required for gH maturation and membrane expression. We recently demonstrated that in the VZV system, the gH:gL complex facilitated cell membrane fusion and extensive polykaryon formation in transfected cells (K. M. Duus, C. Hatfield, and C. Grose, Virology 210:429-440, 1995). To further define the functions of the unusual VZV gL chaperone protein, we have performed a series of mutagenesis experiments with both gH and gL and analyzed the mutants by laser scanning confocal microscopy in a transfection-based fusion assay. We established the fact that immature gH exited the endoplasmic reticulum (ER) when coexpressed with either gE or gI and appeared on the cell surface in a patch pattern. A similar effect was observed on the cell surface with gH with a cytoplasmic tail mutagenized to closely resemble the vaccinia virus hemagglutinin cytoplasmic tail. Site-directed mutagenesis of the five gL cysteine residues demonstrated that four of five cysteines participated in the gL chaperone function required for proper maturation of gH. On the other hand, the same gL mutants facilitated transport of immature gH to the cell surface, where patching occurred. Studies of gL processing demonstrated that maturation did not require transport beyond the medial-Golgi; furthermore, gL was not detected in the outer cell membrane, nor was it secreted into the medium. Colocalization studies with 3,3'-dihexyloxa-cabocyanine iodide and N-(e-7-nitrobenz-2-oxa-1,3-diazol-4-yl-aminocaproyl)-D-erythro-sphingosine confirmed that gL was found primarily in the ER and cis/medial-Golgi when expressed alone. When all of these data were considered, they suggested a posttranslational g

  10. Pharmacokinetics and tolerability of single oral doses of 882C87, a potent, new anti-varicella-zoster virus agent, in healthy volunteers.

    PubMed Central

    Peck, R W; Weatherley, B C; Wootton, R; Crome, P; Holdich, T A; Posner, J

    1995-01-01

    882C87 is a nucleoside analog with potent, specific activity against varicella-zoster virus. It is approximately seven times as potent as acyclovir with an in vitro 50% inhibitory concentration of 1 to 2 microM. The tolerability and pharmacokinetics of single doses of 882C87 have been investigated in a series of studies with healthy young and elderly adult volunteers. The young received 50 to 1,600 mg, and the elderly received 50 and 100 mg. Concentrations of 882C87 and its main metabolite, the pyrimidine base 5-(1-propynyl)uracil (5PU), in plasma and urine were assayed by an automated sequential trace enrichment of dialysate-high-performance liquid chromatography procedure, and noncompartmental pharmacokinetic parameters were derived from the data. Concentrations of 882C87 in plasma increased proportionally for doses of up to 400 mg, but after higher doses the increase was less than dose proportional. In young adults, after 200, 400, and 1,600 mg, the maximum concentrations of the drug in plasma were 9.0, 16.3, and 34.7 microM, respectively, and the areas under the concentration-time curve (AUC) from 0 h to infinity were 166.6, 333.7, and 822.9 microM.h, respectively. Elimination half-life was 11.3 to 13.0 h after 50 to 400 mg, increasing to 15.3 h after 1,600 mg, associated with a small decrease in renal clearance. In healthy elderly volunteers concentrations of 882C87 in plasma after 50 and 100 mg were similar to those in young adults after twice the dose; apparent clearance and renal clearance were significantly reduced, and half-life was significantly longer at 15 h. Administration of 882C87 with food produced a small, nonsignificant reduction in mean AUC from 0 h to infinity, but in subjects with a low fasting AUC there was an increase after food and in subjects with a high fasting AUC there was a decrease. Concentrations of 5PU in plasma were one-third to one-half those of 882C87 and, in most subjects, were not dose proportional. There was a lag of at least

  11. Universal varicella vaccine immunization in Japan.

    PubMed

    Yoshikawa, Tetsushi; Kawamura, Yoshiki; Ohashi, Masahiro

    2016-04-01

    In 1974, Japanese scientists developed a live attenuated varicella vaccine based on the Oka strain. The efficacy of the vaccine for the prevention of varicella has been primarily demonstrated in studies conducted in the United States following the adoption of universal immunization using the Oka strain varicella vaccine in 1996. Although the vaccine was developed by Japanese scientists, until recently, the vaccine has been administered on a voluntary basis in Japan resulting in a vaccine coverage rate of approximately 40%. Therefore, Japan initiated universal immunization using the Oka strain varicella vaccine in November 2014. Given the transition from voluntary to universal immunization in Japan, it will also be important to monitor the epidemiology of varicella and herpes zoster. The efficacy and safety of co-administration of the varicella vaccine and measles, mumps, and rubella vaccine have been demonstrated in many countries; however, there was no data from Japan. In order to adopt the practice of universal immunization using the Oka strain varicella vaccine in Japan, data demonstrating the efficacy and safety of co-administration of varicella vaccine and measles and rubella (MR) vaccine were required. Additionally, we needed to elucidate the appropriate time interval between the first and second administrations of the vaccine. It is also important to differentiate between wild type and Oka vaccine type strains in herpes zoster patient with past history of varicella vaccine. Thus, there are many factors to consider regarding the adoption of universal immunization in Japan to control varicella zoster virus (VZV) infections. PMID:26944711

  12. Recurrent varicella in an immunocompetent woman.

    PubMed

    Dyer, Joseph; Greenfield, Melinda

    2016-01-01

    Varicella-zoster virus (VZV) infection causes 2 distinct disease processes. Primary VZV infection results in varicella (chickenpox), a common generalized eruption, and subsequent reactivation of VZV classically results in herpes zoster (shingles), which presents as a unilateral, dermatomal eruption. Although a single VZV infection typically confers protection against its reactivation, recurrent varicella rarely is reported, particularly in immunocompetent patients. We present the case of a 52-year-old black woman with an intact immune system who demonstrated 3 VZV infections. PMID:26919358

  13. Dysregulated microRNA Expression in Serum of Non-Vaccinated Children with Varicella

    PubMed Central

    Qi, Yuhua; Zhu, Zheng; Shi, Zhiyang; Ge, Yiyue; Zhao, Kangchen; Zhou, Minghao; Cui, Lunbiao

    2014-01-01

    Circulating microRNAs (miRNAs) may play an important role in pathogen-host interactions and can serve as molecular markers for the detection of infectious diseases. To date, the relationship between circulating miRNAs and varicella-zoster virus (VZV) caused varicella has not been reported. Using TaqMan Low-Density Array (TLDA) analysis, expression levels of miRNAs in serum samples from 29 patients with varicella and 60 patients with Bordetella pertussis (BP), measles virus (MEV) and enterovirus (EV) were analyzed. The array results showed that 247 miRNAs were differentially expressed in sera of the varicella patients compared with healthy controls (215 up-regulated and 32 down-regulated). Through the following qRT-PCR confirmation and receiver operational characteristic (ROC) curve analysis, five miRNAs (miR-197, miR-629, miR-363, miR-132 and miR-122) were shown to distinguish varicella patients from healthy controls and other microbial infections with moderate sensitivity and specificity. A number of significantly enriched pathways regulated by these circulating miRNAs were predicted, and some of them were involved in inflammatory response, nervous system and respiratory system development. Our results, for the first time, revealed that a number of miRNAs were differentially expressed during VZV infection, and these five serum miRNAs have great potential to serve as biomarkers for the diagnosis of VZV infection in varicella patients. PMID:24759212

  14. Modeling the effects of varicella vaccination programs on the incidence of chickenpox and shingles.

    PubMed

    Schuette, M C; Hethcote, H W

    1999-11-01

    Two possible dangers of an extensive varicella vaccination program are more varicella (chickenpox) cases in adults, when the complication rates are higher, and an increase in cases of zoster (shingles). Here an age-structured epidemiologic-demographic model with vaccination is developed for varicella and zoster. Parameters are estimated from epidemiological data. This mathematical and computer simulation model is used to evaluate the effects of varicella vaccination programs. Although the age distribution of varicella cases does shift in the simulations, this does not seem to be a danger because many of the adult cases occur after vaccine-induced immunity wanes, so they are mild varicella cases with fewer complications. In the simulations, zoster incidence increases in the first three decades after initiation of a vaccination program, because people who had varicella in childhood age without boosting, but then it decreases. Thus the simulations validate the second danger of more zoster cases. PMID:17879870

  15. Disseminated herpes zoster ophthalmicus in an immunocompetent 8-year old boy.

    PubMed

    Oladokun, Regina Eziuka; Olomukoro, Chikodili N; Owa, Adewale B

    2013-08-01

    Varicella results from a primary infection with the varicella virus while herpes zoster is caused by a reactivation of a latent infection. Dissemination of herpes zoster is uncommon in immunocompetent individuals. Reports of disseminated herpes zoster in children are even less common than in adults. An unusual case of disseminated herpes zoster ophthalmicus in an 8-year old immunocompetent black boy is presented. He had a previous primary Varicella zoster virus infection at three years of age. In the current report, he presented during an on-going chicken pox outbreak and survived with no significant complications. A breakthrough varicella virus re-infection or a reactivation is possible, both of which could present as zoster. This case emphasizes the need for prevention of varicella virus infection through universal childhood immunization and effective infection control strategies in health care settings. PMID:24765504

  16. Pharmacologic management of herpes zoster and postherpetic neuralgia.

    PubMed Central

    Mamdani, F. S.

    1994-01-01

    Herpes zoster is an infection caused by reactivation of dormant varicella-zoster virus. The acute course of herpes zoster is generally benign; however, some patients will experience postherpetic neuralgia characterized by severe, relentless, and at times disabling pain that is often refractory to treatment. While herpes zoster responds to acyclovir, cost-benefit considerations limit the drug's usefulness to only a select group. Postherpetic neuralgia requires a holistic approach, including pharmacologic therapy using several different classes of drugs. PMID:7907508

  17. Herpes zoster duplex bilateralis in an immunocompetent host.

    PubMed

    Gahalaut, Pratik; Chauhan, Sandhya

    2012-01-01

    Varicella zoster virus causes both chicken pox and herpes zoster. The phenomenon of herpes zoster occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB). Few cases, reported in the literature, were seen in either an immunosuppressed host or in the older age group. Here we present a case of HZDB in an immunocompetent host, probably the first in India. PMID:23130258

  18. Primary varicella infection presenting with headache and elevated intracranial pressure.

    PubMed

    Gilad, Oded; Shefer-Averbuch, Noa; Garty, Ben Zion

    2015-05-01

    Primary varicella infection may be associated with neurologic complications, such as cerebritis and meningoencephalitis. Several cases of varicella infection with elevated intracranial pressure have been reported. We describe a 13-year-old immunocompetent girl who presented with a clinical picture of headaches and elevated intracranial pressure as the only manifestation of primary varicella zoster infection. The working diagnosis at first was pseudotumor cerebri based on complaints of headache of 2 weeks' duration, in addition to vomiting and papilledema, without fever or skin eruption. On lumbar puncture, opening pressure was 420 mmH2O, but mild pleocytosis and mildly elevated protein level ruled out the diagnosis of pseudotumor cerebri. Our patient had no history of previous varicella infection, and she did not receive the varicella zoster vaccine. Serology tests, done on admission and repeated 2 months later, suggested primary varicella infection. The literature on varicella infection associated with pseudotumor cerebri or elevated intracranial pressure is reviewed. PMID:24846901

  19. The differences in short- and long-term varicella-zoster virus (VZV) immunoglobulin G levels following varicella vaccination of healthcare workers measured by VZV fluorescent-antibody-to-membrane-antigen assay (FAMA), VZV time-resolved fluorescence immunoassay and a VZV purified glycoprotein enzyme immunoassay.

    PubMed

    Maple, P A C; Haedicke, J; Quinlivan, M; Steinberg, S P; Gershon, A A; Brown, K E; Breuer, J

    2016-08-01

    Healthcare workers (HCWs) reporting no history of varicella frequently receive varicella vaccination (vOka) if they test varicella-zoster virus (VZV) immunoglobulin G (IgG) negative. In this study, the utilities of VZV-IgG time-resolved fluorescence immunoassay (VZV-TRFIA) and a commercial VZV-IgG purified glycoprotein enzyme immunoassay (gpEIA) currently used in England for confirming VZV immunity have been compared to the fluorescent-antibody-to-membrane-antigen assay (FAMA). A total of 110 HCWs received two doses of vOka vaccine spaced 6 weeks apart and sera collected pre-vaccination (n = 100), at 6 weeks post-completion of vaccination (n = 86) and at 12-18 months follow-up (n = 73) were analysed. Pre-vaccination, by FAMA, 61·0% sera were VZV IgG negative, and compared to FAMA the sensitivities of VZV-TRFIA and gpEIA were 74·4% [95% confidence interval (CI) 57·9-87·0] and 46·2% (95% CI 30·1-62·8), respectively. Post-completion of vaccination the seroconversion rate by FAMA was 93·7% compared to rates of 95·8% and 70·8% determined by VZV-TRFIA and gpEIA, respectively. At 12-18 months follow-up seropositivity rates by FAMA, VZV-TRFIA and gpEIA were 78·1%, 74·0% and 47·9%, respectively. Compared to FAMA the sensitivities of VZV-TRFIA and gpEIA for measuring VZV IgG following vaccination were 96·4% (95% CI 91·7-98·8) and 74·6% (95% CI 66·5-81·6), respectively. Using both FAMA and VZV-TRFIA to identify healthy adult VZV susceptibles and measure seroconversion showed that vOka vaccination of HCWs is highly immunogenic. PMID:27018820

  20. Herpes zoster segmental paresis in an immunocompromised breast cancer woman

    PubMed Central

    Rastegar, Shirvan; Mahdavi, Sadegh Baradaran; Mahmoudi, Farhad; Basiri, Keivan

    2015-01-01

    Herpes zoster is an infectious disease with neurological complications caused by reactivation of varicella zoster virus in dorsal root ganglia of spinal cord which is also known as “Shingles.” Suppression of immune system is the major predisposing factor for reactivation of latent virus. Disease is mainly characterized by rash, vesicles and pain along one or more dermatomes which are innervated from one or more spinal nerve roots. Complications may be present after a while despite of patient treatment. Motor involvement is included. Some previous studies showed segmental zoster paresis as a rare complication, a few weeks after first presentation, among immunocompetent individuals. We present post herpetic motor involvement of C5 and C6 in a 59-year-old woman who underwent chemotherapy and radiotherapy due to breast cancer, manifesting left upper limb weakness and paresis, 6 months after left partial mastectomy. Segmental paresis of zoster virus should be considered as a cause of motor impairment in an immunocompromised person suffering from shingles. PMID:26436084

  1. Congenital varicella syndrome: A systematic review.

    PubMed

    Ahn, Ki Hoon; Park, Yun-Jung; Hong, Soon-Cheol; Lee, Eun Hee; Lee, Ji-Sung; Oh, Min-Jeong; Kim, Hai-Joong

    2016-07-01

    Varicella-zoster virus (VZV) is a teratogen that can cross the placenta and cause the congenital varicella syndrome (CVS), which is characterised by multi-system anomalies. There have been 130 reported cases of CVS from 1947 to 2013. The estimated incidence of CVS was 0.59% and 0.84% for women infected with VZV during the entire pregnancy and for those infected the first 20 weeks of pregnancy, respectively. Nine cases were reported at 21-27 weeks of gestation and one case was identified at 36 weeks. Herpes zoster caused CVS in two cases. Regarding treatment, varicella zoster immunoglobulin treatment, irrespective of gestational age, should be considered in addition to antiviral drugs for women who have been exposed to or infected with virus. PMID:26965725

  2. The Insulin Degrading Enzyme Binding Domain of Varicella-Zoster Virus (VZV) Glycoprotein E is Important for Cell-to-Cell Spread and VZV Infectivity, while a Glycoprotein I Binding Domain is Essential for Infection

    PubMed Central

    Ali, Mir A.; Li, Qingxue; Fischer, Elizabeth R.; Cohen, Jeffrey I.

    2009-01-01

    Varicella-zoster virus (VZV) glycoprotein E (gE) interacts with glycoprotein I and with insulin degrading enzyme (IDE), which is a receptor for the virus. We found that a VZV gE deletion mutant could only be grown in cells expressing gE. Expression of VZV gE on the surface of cells did not interfere with VZV infection. HSV deleted for gE is impaired for cell-to-cell spread; VZV gE could not complement this activity in an HSV gE null mutant. VZV lacking the IDE binding domain of gE grew to peak titers nearly equivalent to parental virus; however, it was impaired for cell-to-cell spread and for infectivity with cell-free virus. VZV deleted for a region of gE that binds glycoprotein I could not replicate in cell culture unless grown in cells expressing gE. We conclude that the IDE binding domain is important for efficient cell-to-cell spread and infectivity of cell-free virus. PMID:19233447

  3. A tyrosine-based motif and a casein kinase II phosphorylation site regulate the intracellular trafficking of the varicella-zoster virus glycoprotein I, a protein localized in the trans-Golgi network.

    PubMed Central

    Alconada, A; Bauer, U; Hoflack, B

    1996-01-01

    We have studied the intracellular trafficking of the envelope glycoprotein I (gpI) of the varicella-zoster virus, a human herpes virus whose assembly is believed to occur in the trans-Golgi network (TGN) and/or in endocytic compartments. When expressed in HeLa cells in the absence of additional virally encoded factors, this type-I membrane protein localizes to the TGN and cycles between this compartment and the cell surface. The expression of gpI promotes the recruitment of the AP-1 Golgi-specific assembly proteins onto TGN membranes, strongly suggesting that gpI, like the mannose 6-phosphate receptors, can leave the TGN in clathrin-coated vesicles for subsequent transport to endosomes. Its return from the cell surface to the TGN also occurs through endosomes. The transfer of the gpI cytoplasmic domain onto a reporter molecule shows that this domain is sufficient to confer TGN localization. Mutational analysis of this domain indicates that proper subcellular localization and cycling of gpI depend on two different determinants, a tyrosine-containing tetrapeptide related to endocytosis sorting signals and a cluster of acidic amino acids containing casein kinase II phosphorylatable residues. Thus, the VZV gpI and the mannose 6-phosphate receptors, albeit localized in different intracellular compartments at steady-state, follow similar trafficking pathways and share similar sorting mechanisms. Images PMID:8947032

  4. Simian Varicella Virus: Molecular Virology

    PubMed Central

    Gray, Wayne L.

    2012-01-01

    Simian varicella virus (SVV) is a primate herpesvirus that is closely related to varicella-zoster virus (VZV), the causative agent of varicella (chickenpox) and herpes zoster (shingles). Epizootics of simian varicella occur sporadically in facilities housing Old World monkeys. This review summarizes the molecular properties of SVV. The SVV and VZV genomes are similar in size, structure, and gene arrangement. The 124.5 kilobase pair (kbp) SVV genome includes a 104.7 kbp long (L) component covalently linked to a short (S) component which includes a 4.9 kbp unique short (US) segment flanked by 7.5 kbp inverted repeat sequences. SVV DNA encodes 69 distinct open reading frames (ORFs), three of which are duplicated within the viral inverted repeats. The viral genome is coordinately expressed and immediate early (IE), early, and late genes have been characterized. Genetic approaches have been developed to create SVV mutants, which will be used to study the role of SVV genes in viral pathogenesis, latency, and reactivation. In addition, SVV expressing foreign genes are being investigated as potential recombinant varicella vaccines. PMID:20369316

  5. Varicella Pneumonia in a 39-year-old Female in Third Trimester Twin Pregnancy

    PubMed Central

    Baljic, Rusmir; Hadzovic, Meliha; Mehanic, Snjezana; Lukovac, Enra; Koluder-Cimic, Nada; Baljic, Izet; Imsirovic, Bilal

    2012-01-01

    SUMMARY CONFLICT OF INTEREST: none declared. Introduction Chickenpox is disease caused by varicella-zoster virus (VZV), with possibly devastated consequences during pregnancy, for mother and neonate. Pneumonia is most common complication in pregnancy with very high mortality. Case report A 39-year-old female in third trimester twin pregnancy, referred to Clinic for infectious diseases in Sarajevo, with five days history of illness. Before the admission her condition get worse, with fatigue, exhaustion, and shortness of breath. In a first three days patient was febrile, tachydispnoic and ortopnoic. We started therapy with acyclovir and antibiotic. After four days we had detoriation in patient’s condition. Chest X-ray revealed infiltrative shadows in basal parts of lung. Antimicrobial therapy was changed and corticosteroids were associated. Significant improvement was noticed after five days of therapy. Conclusion Varicella pneumonia during third trimester may have serious consequences for mother and child, with possible fatal outcome. PMID:24493990

  6. The Uncommon Localization of Herpes Zoster

    PubMed Central

    Cukic, Vesna

    2016-01-01

    Introduction: Herpes zoster is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus (VZV) that is the cause of varicella. It is an acute neurological disease which can often lead to serious postherpetic neuralgia (PHN). Different nerves can be included with the skin rash in the area of its enervation especially cranial nerves (CV) and intercostal nerves. Case report: In this report we present a patient with herpes zoster which involved ulnar nerve with skin rash in the region of ulnar innervations in women with no disease previously diagnosed. The failure of her immune system may be explained by great emotional stress and overwork she had been exposed to with neglecting proper nutrition in that period. Conclusion: Herpes zoster may involve any nerve with characteristic skin rash in the area of its innervations, and failure in immune system which leads reactivation of VZV may be caused by other factors besides the underlying illness. PMID:26980938

  7. [Cutaneous leishmaniasis and multidermatomic herpes zoster].

    PubMed

    Arboleda, Margarita; Jaramillo, Laura; Ortiz, Diana; Díaz, Alejandro

    2013-12-01

    Standard treatment of leishmaniasis consists of n-metilglucamine, meglumine antimoniate, which can trigger side effects such as general malaise, renal and hepatic impairment, and cardiac arrhythmias. Infrequently, reactivations of varicella-zoster virus infections have been reported. This paper describes a patient with cutaneous leishmaniasis in treatment with meglumine and herpes zoster multiplex. After ruling out other possible causes of immunosuppression, an acyclovir therapy was initiated. PMID:24522317

  8. SUNCT headaches after ipsilateral ophthalmic-distribution zoster.

    PubMed

    Nagel, Maria A; Burns, Ted M; Gilden, Don

    2016-07-15

    Nine days after left ophthalmic-distribution zoster, a 47-year-old man developed SUNCT headaches (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing). In contrast to two prior cases of SUNCT that developed after varicella zoster virus (VZV) meningoencephalitis without rash, this case describes an association of SUNCT with overt zoster, thus adding to the spectrum of headache and facial pain syndromes caused by VZV reactivation. PMID:27288808

  9. Varicella-zoster virus (VZV) transcription during latency in human ganglia: detection of transcripts mapping to genes 21, 29, 62, and 63 in a cDNA library enriched for VZV RNA.

    PubMed Central

    Cohrs, R J; Barbour, M; Gilden, D H

    1996-01-01

    Information on the extent of virus DNA transcription and translation in infected tissue is crucial to an understanding of herpesvirus latency. To detect low-abundance latent varicella-zoster virus (VZV) transcripts, poly(A)+ RNA extracted from latently infected human trigeminal ganglia was enriched for VZV transcripts by hybridization to biotinylated VZV DNA. After hybridization, the RNA-DNA hybrid was isolated by binding to avidin-coated beads and extensively washed, and the RNA was released by heat denaturation. A lambda-based cDNA library was then constructed from the enriched RNA. PCR and DNA sequencing of DNA extracted from the cDNA library revealed the presence of VZV genes 21, 29, 62, and 63, but not VZV genes 4, 10, 40, 51, and 61, in the enriched cDNA library. These findings confirm the detection of VZV gene 29 and 62 transcripts on Northern (RNA) blots prepared from latently infected human ganglia (J.L. Meier, R.P. Holman, K.D. Croen, J.E. Smialek, and S.E. Straus, Virology 193:193-200, 1993) and the presence of VZV gene 21 transcripts in a cDNA library from mRNA of latently infected ganglia (R.J. Cohrs, K. Srock, M.B. Barbour, G. Owens, R. Mahalingam, M.E. Devlin, M. Wellish and D.H. Gilden, J. Virol. 68:7900-7908,1994) and also reveal, for the first time, the presence of VZV gene 63 RNA in latently infected human ganglia. PMID:8627753

  10. Differentiation of Varicella-Zoster Virus ORF47 Protein Kinase and IE62 Protein Binding Domains and Their Contributions to Replication in Human Skin Xenografts in the SCID-hu Mouse

    PubMed Central

    Besser, Jaya; Sommer, Marvin H.; Zerboni, Leigh; Bagowski, Christoph P.; Ito, Hideki; Moffat, Jennifer; Ku, Chia-Chi; Arvin, Ann M.

    2003-01-01

    To investigate the role of the ORF47 protein kinase of varicella-zoster virus (VZV), we constructed VZV recombinants with targeted mutations in conserved motifs of ORF47 and a truncated ORF47 and characterized these mutants for replication, phosphorylation, and protein-protein interactions in vitro and for infectivity in human skin xenografts in the SCID-hu mouse model in vivo. Previous experiments showed that ROka47S, a null mutant that makes no ORF47 protein, did not replicate in skin in vivo (J. F. Moffat, L. Zerboni, M. H. Sommer, T. C. Heineman, J. I. Cohen, H. Kaneshima, and A. M. Arvin, Proc. Natl. Acad. Sci. USA 95:11969-11974, 1998). The construction of VZV recombinants with targeted ORF47 mutations made it possible to assess the effects on VZV infection of human skin xenografts of selectively abolishing ORF47 protein kinase activity. ORF47 mutations that resulted in a C-terminal truncation or disrupted the DYS kinase motif eliminated ORF47 kinase activity and were associated with extensive nuclear retention of ORF47 and IE62 proteins in vitro. Disrupting ORF47 kinase function also resulted in a marked decrease in VZV replication and cutaneous lesion formation in skin xenografts in vivo. However, infectivity in vivo was not blocked completely as long as the capacity of ORF47 protein to bind IE62 protein was preserved, a function that we identified and mapped to the N-terminal domain of ORF47 protein. These experiments indicate that ORF47 kinase activity is of critical importance for VZV infection and cell-cell spread in human skin in vivo but suggest that it is the formation of complexes between ORF47 and IE62 proteins, both VZV tegument components, that constitutes the essential contribution of ORF47 protein to VZV replication in vivo. PMID:12719588

  11. Development and Validation of a Laboratory-Developed Multiplex Real-Time PCR Assay on the BD Max System for Detection of Herpes Simplex Virus and Varicella-Zoster Virus DNA in Various Clinical Specimens

    PubMed Central

    Pillet, Sylvie; Verhoeven, Paul O.; Epercieux, Amélie; Bourlet, Thomas

    2015-01-01

    A multiplex real-time PCR (quantitative PCR [qPCR]) assay detecting herpes simplex virus (HSV) and varicella-zoster virus (VZV) DNA together with an internal control was developed on the BD Max platform combining automated DNA extraction and an open amplification procedure. Its performance was compared to those of PCR assays routinely used in the laboratory, namely, a laboratory-developed test for HSV DNA on the LightCycler instrument and a test using a commercial master mix for VZV DNA on the ABI7500fast system. Using a pool of negative cerebrospinal fluid (CSF) samples spiked with either calibrated controls for HSV-1 and VZV or dilutions of a clinical strain that was previously quantified for HSV-2, the empirical limit of detection of the BD Max assay was 195.65, 91.80, and 414.07 copies/ml for HSV-1, HSV-2, and VZV, respectively. All the samples from HSV and VZV DNA quality control panels (Quality Control for Molecular Diagnostics [QCMD], 2013, Glasgow, United Kingdom) were correctly identified by the BD Max assay. From 180 clinical specimens of various origins, 2 CSF samples were found invalid by the BD Max assay due to the absence of detection of the internal control; a concordance of 100% was observed between the BD Max assay and the corresponding routine tests. The BD Max assay detected the PCR signal 3 to 4 cycles earlier than did the routine methods. With results available within 2 h on a wide range of specimens, this sensitive and fully automated PCR assay exhibited the qualities required for detecting simultaneously HSV and VZV DNA on a routine basis. PMID:25878344

  12. Targeting of glycoprotein I (gE) of varicella-zoster virus to the trans-Golgi network by an AYRV sequence and an acidic amino acid-rich patch in the cytosolic domain of the molecule.

    PubMed Central

    Zhu, Z; Hao, Y; Gershon, M D; Ambron, R T; Gershon, A A

    1996-01-01

    Previous studies suggested that varicella-zoster virus (VZV) envelope glycoproteins (gps) are selectively transported to the trans-Golgi network (TGN) and that the cytosolic domain of gpI (gE) targets it to the TGN. To identify targeting signals in the gpI cytosolic domain, intracellular protein trafficking was studied in transfected cells expressing chimeric proteins in which a full-length or mutated gpI cytosolic domain was fused to the gpI transmembrane domain and interleukin-2 receptor (tac) ectodomain. Expressed protein was visualized with antibodies to tac. A targeting sequence (AYRV) and a second, acidic amino acid-rich region of the gpI cytosolic domain (putative signal patch) were each sufficient to cause expressed protein to colocalize with TGN markers. This targeting was lost when the tyrosine of the AYRV sequence was replaced with glycine or lysine, when arginine was replaced with glutamic acid, or when valine was substituted with lysine. In contrast, tyrosine could be replaced by phenylalanine and valine could be substituted with leucine. Mutation of alanine to aspartic acid or deletion of alanine abolished TGN targeting. Exposure of transfected cells to antibodies to the tac ectodomain revealed that the TCN targeting of expressed tac-gpI chimeric proteins occurred as a result of selective retrieval from the plasmalemma. These data suggest that the AYRV sequence and a second signaling patch in the cytosolic domain of gpI are responsible for its targeting to the TGN. The observations also support the hypothesis that the TGN plays a critical role in the envelopment of VZV. PMID:8794291

  13. In Vitro-Selected Drug-Resistant Varicella-Zoster Virus Mutants in the Thymidine Kinase and DNA Polymerase Genes Yield Novel Phenotype-Genotype Associations and Highlight Differences between Antiherpesvirus Drugs

    PubMed Central

    Topalis, D.; Fiten, P.; McGuigan, C.; Balzarini, J.; Opdenakker, G.; Snoeck, R.

    2012-01-01

    Varicella zoster virus (VZV) is usually associated with mild to moderate illness in immunocompetent patients. However, older age and immune deficiency are the most important risk factors linked with virus reactivation and severe complications. Treatment of VZV infections is based on nucleoside analogues, such as acyclovir (ACV) and its valyl prodrug valacyclovir, penciclovir (PCV) as its prodrug famciclovir, and bromovinyldeoxyuridine (BVDU; brivudin) in some areas. The use of the pyrophosphate analogue foscarnet (PFA) is restricted to ACV-resistant (ACVr) VZV infections. Since antiviral drug resistance is an emerging problem, we attempt to describe the contributions of specific mutations in the viral thymidine kinase (TK) gene identified following selection with ACV, BVDU and its derivative BVaraU (sorivudine), and the bicyclic pyrimidine nucleoside analogues (BCNAs), a new class of potent and specific anti-VZV agents. The string of 6 Cs at nucleotides 493 to 498 of the VZV TK gene appeared to function as a hot spot for nucleotide insertions or deletions. Novel amino acid substitutions (G24R and T86A) in VZV TK were also linked to drug resistance. Six mutations were identified in the “palm domain” of VZV DNA polymerase in viruses selected for resistance to PFA, PCV, and the 2-phophonylmethoxyethyl (PME) purine derivatives. The investigation of the contributions of specific mutations in VZV TK or DNA polymerase to antiviral drug resistance and their impacts on the structures of the viral proteins indicated specific patterns of cross-resistance and highlighted important differences, not only between distinct classes of antivirals, but also between ACV and PCV. PMID:22190713

  14. Increased large unstained cells value in varicella patients: A valuable parameter to aid rapid diagnosis of varicella infection.

    PubMed

    Shin, Dongyun; Lee, Min Seok; Kim, Do Young; Lee, Min-Geol; Kim, Dae Suk

    2015-08-01

    Varicella is a highly contagious infection caused by varicella zoster virus. Sometimes it is difficult to differentiate between other viral infections such as Kaposi's varicelliform eruption (KVE) and disseminated herpes zoster (HZ). The large unstained cells (LUC) value is a differential count parameter reported by routing hematology analysis. LUC have been studied previously, but never been reported in the context of varicella or in dermatological published work. The aim of this study was to compare the LUC values in varicella patients with that in KVE and disseminated HZ patients. Sixty-nine varicella patients, 30 KVE patients and 11 disseminated HZ patients were included in this retrospective study. All data were analyzed using SPSS version 17.0 or GraphPad Prism version 5.0. The mean percentage of LUC (%LUC) in varicella patients was higher than the upper limit of normal reference range and it was increased compared to %LUC of both KVE (P < 0.0001) and disseminated HZ (P = 0.0051) patients. %LUC of varicella patients significantly decreased with clinical improvements (P = 0.0017). %LUC was significantly increased in varicella patients and corresponded with clinical improvements. Patients with %LUC of 3.55 or more favor the diagnosis of varicella over both KVE and disseminated HZ with 71.01% sensitivity and 84.44% specificity. We suggest that %LUC can assist in making a precise diagnosis of varicella in confusing cases. PMID:25916861

  15. Prodromal herpes zoster mimicking odontalgia--a diagnostic challenge.

    PubMed

    Patil, Shilpa; Srinivas, K; Reddy, Bh Satheesha; Gupta, Mudit

    2013-03-01

    Herpes zoster (shingles) is caused by reactivation of the latent varicella zoster virus which is present due to an earlier varicella infection (chicken-pox). Herpes Zoster is a less common and endemic disease than varicella, although factors causing reactivation are still not well known, but it occurs in older and/or immunocompromised individuals. Involvement of C3, T5, L1, L2 and first division of trigeminal nerve are the most frequently encountered whereas the involvement of second and third division of trigeminal nerve is rarely seen. During the prodromal stage, the only presenting symptom may be odontalgia, which may prove to be a diagnostic challenge for the dentist, since many diseases can cause orofacial pain, and the diagnosis must be properly established before final treatment. Here we present a case of herpes zoster involving the second division of trigeminal nerve masquerading as odontalgia. The difficulties in diagnosis and management are discussed. PMID:23559842

  16. Disseminated Cutaneous Herpes Zoster in a Patient with Uncontrolled Diabetes Mellitus.

    PubMed

    Malkud, Shashikant; Patil, Santosh M

    2015-07-01

    Herpes zoster is a clinical manifestation which results from reactivation of latent VZV (Varicella zoster virus) present in the sensory root ganglia. Disseminated herpes zoster has been reported in immune-compromised patients such as patient on cancer chemotherapy, HIV (Human immune deficiency virus) infection, systemic corticosteroid therapy. However, we report a case of disseminated herpes zoster infection in an uncontrolled diabetic patient. A brief review of literature on this topic has been bestowed. PMID:26393187

  17. Disseminated Cutaneous Herpes Zoster in a Patient with Uncontrolled Diabetes Mellitus

    PubMed Central

    Patil, Santosh M

    2015-01-01

    Herpes zoster is a clinical manifestation which results from reactivation of latent VZV (Varicella zoster virus) present in the sensory root ganglia. Disseminated herpes zoster has been reported in immune-compromised patients such as patient on cancer chemotherapy, HIV (Human immune deficiency virus) infection, systemic corticosteroid therapy. However, we report a case of disseminated herpes zoster infection in an uncontrolled diabetic patient. A brief review of literature on this topic has been bestowed. PMID:26393187

  18. Zeroing in on zoster: A tale of many disorders produced by one virus.

    PubMed

    Galetta, Kristin M; Gilden, Don

    2015-11-15

    While herpes zoster infection has been recognized since antiquity, chickenpox (varicella) was confused with smallpox until the 1800s, when both illnesses became better understood. In the 20th century, varicella zoster virus (VZV) was shown to cause varicella upon primary (first-time) infection and herpes zoster (shingles) after reactivation of latent VZV. Scientific progress over the past 50 years has rapidly advanced the understanding and prevention of disease produced by VZV. Combined imaging and virological studies continue to reveal the protean neurological, ocular and visceral disorders produced by VZV. PMID:26454371

  19. [Manifestation of Zoster in the Oral Cavity].

    PubMed

    Vered, M; Zlotogorski-Hurvitz, A

    2016-01-01

    Zoster (shingles) is assumed to affect 10-20% of the individuals who have been exposed to the varicella zoster virus (VZV). It is expected to develop among the elderly, usually on the background of a weakened immune system. In those cases that the trigeminal branches are involved by zoster, unilateral mucosal and cutaneous vesiculo-ulcerative lesions will develop. Intense pain usually precedes the overt lesions of zoster, which sometimes might mimic acute pain of dental origin. Careful anamnesis and thorough clinical examination should lead to a correct diagnosis. Since zoster, in general, is associated with serious morbidity, including post-herpetic neuralgia, ocular damage and hearing deficits, the Centers for Disease Control and Prevention (CDC) currently recommend shingles vaccination, especially for those who are > 60-year old. PMID:27295930

  20. Successes and challenges in varicella vaccine

    PubMed Central

    Papaloukas, Orestis; Giannouli, Georgia

    2014-01-01

    Varicella is a highly contagious disease caused by primary infection with varicella zoster virus (VZV). VZV infection, as well as varicella vaccination, induces VZV-specific antibody and T-cell-mediated immunity, essential for recovery. The immune responses developed contribute to protection following re-exposure to VZV. When cell-mediated immunity declines, as occurs with aging or immunosuppression, reactivation of VZV leads to herpes zoster (HZ). It has been almost 20 years since universal varicella vaccination has been implemented in many areas around the globe and this has resulted in a significant reduction of varicella-associated disease burden. Successes are reviewed here, whilst emphasis is put on the challenges ahead. Most countries that have not implemented routine childhood varicella vaccination have chosen to vaccinate high-risk groups alone. The main reasons for not introducing universal vaccination are discussed, including fear of age shift of peak incidence age and of HZ incidence increase. Possible reasons for not observing the predicted increase in HZ incidence are explored. The advantages and disadvantages of universal vs targeted vaccination as well as different vaccination schedules are discussed. PMID:24757524

  1. Efficacy of varicella (VZV) vaccination: an update for the clinician

    PubMed Central

    Wang, Lili; Zhu, Lucy; Zhu, Hua

    2016-01-01

    Varicella-zoster virus (VZV) infection causes two distinct clinical conditions. Primary varicella infection results in chickenpox, a contagious rash illness typically seen among children. VZV can reactivate years after the initial infection to cause herpes zoster (HZ) and lead to post-herpetic neuralgia, a common complication resulting in persistent pain that may last for years after the zoster rash resolves. A person’s risk of having longer lasting and more severe pain associated with HZ increases with age. Since the introduction of VZV vaccines, the rates of infection, hospitalizations, and mortality have declined. In this review, we discuss in detail current VZV vaccines available for the prevention of VZV and HZ infections. Varilrix (GSK Biologicals, UK), Varivax (Merck, USA) and the combined measles, mumps, rubella, and varicella (MMRV) vaccine contain the live attenuated Oka strain of VZV for routine varicella vaccination. While Zostavax is the only HZ vaccine currently approved for use in the United States and the European Union [EMEA, 2011], a subunit vaccine candidate called HZ/su has recently shown improved efficacy for zoster prevention in two clinical trial phase III studies. VariZIG, a post-exposure prophylactic, uses zoster immune globulin to prevent VZV infection in those who have recently been in contact with VZV but lack evidence of varicella immunity and are contraindicated to receive the varicella vaccine. Further, we discuss the skin tropic and neurotropic factor VZV ORF7 gene and its involvement in varicella infection, reactivation and latency in ganglia. Ultimately, these studies can contribute to the development of a neuroattenuated vaccine candidate against varicella or a vector for delivery of other virus antigens. PMID:27551429

  2. Efficacy of varicella (VZV) vaccination: an update for the clinician.

    PubMed

    Wang, Lili; Zhu, Lucy; Zhu, Hua

    2016-01-01

    Varicella-zoster virus (VZV) infection causes two distinct clinical conditions. Primary varicella infection results in chickenpox, a contagious rash illness typically seen among children. VZV can reactivate years after the initial infection to cause herpes zoster (HZ) and lead to post-herpetic neuralgia, a common complication resulting in persistent pain that may last for years after the zoster rash resolves. A person's risk of having longer lasting and more severe pain associated with HZ increases with age. Since the introduction of VZV vaccines, the rates of infection, hospitalizations, and mortality have declined. In this review, we discuss in detail current VZV vaccines available for the prevention of VZV and HZ infections. Varilrix (GSK Biologicals, UK), Varivax (Merck, USA) and the combined measles, mumps, rubella, and varicella (MMRV) vaccine contain the live attenuated Oka strain of VZV for routine varicella vaccination. While Zostavax is the only HZ vaccine currently approved for use in the United States and the European Union [EMEA, 2011], a subunit vaccine candidate called HZ/su has recently shown improved efficacy for zoster prevention in two clinical trial phase III studies. VariZIG, a post-exposure prophylactic, uses zoster immune globulin to prevent VZV infection in those who have recently been in contact with VZV but lack evidence of varicella immunity and are contraindicated to receive the varicella vaccine. Further, we discuss the skin tropic and neurotropic factor VZV ORF7 gene and its involvement in varicella infection, reactivation and latency in ganglia. Ultimately, these studies can contribute to the development of a neuroattenuated vaccine candidate against varicella or a vector for delivery of other virus antigens. PMID:27551429

  3. Herpes Zoster Vaccination: Controversies and Common Clinical Questions.

    PubMed

    Van Epps, Puja; Schmader, Kenneth E; Canaday, David H

    2016-01-01

    Herpes zoster, clinically referred to as shingles, is an acute, cutaneous viral infection caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox. The incidence of herpes zoster and its complications increase with decline in cell-mediated immunity, including age-associated decline. The most effective management strategy for herpes zoster is prevention of the disease through vaccination in those who are most vulnerable. Despite the demonstrated efficacy in reducing the incidence and severity of herpes zoster, the uptake of vaccine remains low. Here, we will discuss the controversies that surround the live herpes zoster vaccine and address the common clinical questions that arise. We will also discuss the new adjuvanted herpes zoster vaccine currently under investigation. PMID:26184711

  4. Vascular Complications of Varicella: Description of 4 Cases and a Review of Literature.

    PubMed

    Driesen, Yentl; Verweij, Marjoke; De Maeseneer, Marianne; De Dooy, Jozef; Wojciechowski, Marek; Van Den Akker, Machiel

    2015-11-01

    Stroke and deep venous thrombosis are rare complications of varicella zoster infection. We report 3 cases of children with a stroke and 1 case of a boy with a deep venous thrombosis after recent chicken pox. PMID:26226447

  5. Efficacy of live zoster vaccine in preventing zoster and postherpetic neuralgia

    PubMed Central

    Gilden, D.

    2011-01-01

    Declining cell-mediated immunity to varicella zoster virus (VZV) in elderly individuals results in virus reactivation manifest by zoster (shingles) and postherpetic neuralgia (PHN). To prevent virus reactivation, a new VZV vaccine (Zostavax, Merck) that boosts cell-mediated immunity to VZV was developed. The 3-year Shingles Prevention Study showed that Zostavax significantly reduced burden of disease due to zoster and PHN. Despite its cost-effectiveness for adults ages 65 to 75 years, as determined in the US, Canada and UK, less than 2% of immunocompetent adults over age 60 years in the US were immunized in 2007. This was due to a combination of lack of patient awareness of the vaccine, physicians’ uncertainty about the duration of protection, and different cost-sharing plans for immunization. Nevertheless, zoster vaccine is safe, effective, and highly recommended for immunization of immunocompetent individuals over age 60 years with no history of recent zoster. PMID:21294791

  6. Efficacy of live zoster vaccine in preventing zoster and postherpetic neuralgia.

    PubMed

    Gilden, D

    2011-05-01

    Declining cell-mediated immunity to varicella zoster virus (VZV) in elderly individuals results in virus reactivation manifest by zoster (shingles) and postherpetic neuralgia (PHN). To prevent virus reactivation, a new VZV vaccine (Zostavax; Merck) that boosts cell-mediated immunity to VZV was developed. The 3-year Shingles Prevention Study showed that Zostavax significantly reduced burden of disease because of zoster and PHN. Despite its cost-effectiveness for adults aged 65-75 years, as determined in the United States, Canada and UK, <2% of immunocompetent adults over age 60 years in the United States were immunized in 2007. This was because of a combination of lack of patient awareness of the vaccine, physicians' uncertainty about the duration of protection and different cost-sharing plans for immunization. Nevertheless, zoster vaccine is safe, effective and highly recommended for immunization of immunocompetent individuals over age 60 years with no history of recent zoster. PMID:21294791

  7. Use of a current varicella vaccine as a live polyvalent vaccine vector.

    PubMed

    Murakami, Kouki; Mori, Yasuko

    2016-01-01

    Varicella-zoster virus (VZV) is the causative agent of varicella and zoster. The varicella vaccine was developed to control VZV infection in children. The currently available Oka vaccine strain is the only live varicella vaccine approved by the World Health Organization. We previously cloned the complete genome of the Oka vaccine strain into a bacterial artificial chromosome vector and then successfully reconstituted the virus. We then used this system to generate a recombinant Oka vaccine virus expressing mumps virus gene(s). The new recombinant vaccine may be an effective polyvalent live vaccine that provides protection against both varicella and mumps viruses. In this review, we discussed about possibility of polyvalent live vaccine(s) using varicella vaccine based on our recent studies. PMID:25444800

  8. A case for varicella vaccination in the immunosuppressed

    PubMed Central

    Holmes, Michael Vaclav; Atabani, Sowsan F; Khan, Nasser; Steiner, Kate; Haque, Tanzina; Slapak, Gabrielle

    2009-01-01

    A middle-aged man with long-standing Crohn disease maintained in remission on low-dose immunosuppression presented with abdominal pain. Over the following few days he developed a vesicular rash, became dyspnoeic, confused and had two seizures. Despite high-dose intravenous aciclovir, he died. Disseminated varicella zoster virus, the cause of his death, could potentially have been prevented had he received varicella vaccination at an earlier stage. PMID:21686799

  9. Herpes zoster in the ulnar nerve distribution.

    PubMed

    Athwal, G S; Bartsich, S A; Weiland, A J

    2005-08-01

    Varicella zoster is a ubiquitous virus which usually affects school-aged children as Chicken Pox. While the initial disease is self-limiting and seldom severe, the virus remains in the body. It lies dormant in the dorsal root ganglia and reactivation may occur years later with variable presentations as Herpes Zoster, or Shingles. While Shingles is common, it rarely presents exclusively in the upper extremity. It is important that hand surgeons recognize the possibility of zoster infection, with or without a rash, when evaluating the onset of neuralgia in a dermatomal distribution in the upper limb. Early diagnosis allows rapid and appropriate treatment, with a lower risk of complications. We report on a case of Herpes Zoster isolated to the ulnar nerve distribution in a young woman. PMID:15950335

  10. Persistent Multiple Pulmonary Nodules in a Nonimmunocompromised Woman after Varicella-Related Myelitis Treated with Acyclovir

    PubMed Central

    Schvoerer, Evelyne; Frechin, Valéry; Warter, André; Gasser, Bernard; Jouin, Hervé; Gut, Jean-Pierre; Stoll-Keller, Françoise

    2003-01-01

    Persistent multiple pulmonary nodules were observed on the chest X ray of a nonimmunocompromised woman 6 months after she was treated with acyclovir for a varicella-related myelitis without respiratory symptoms. Early antiviral therapy given for varicella infections might decrease the intensity of clinical symptoms without actually preventing the occurrence of varicella-zoster virus-related lesions such as the persistent pulmonary nodules reported here. PMID:14532257

  11. Complicated Varicella Infection at 8-year-old Boy with Pulmonary Agenesis

    PubMed Central

    Hadzovic–Cengic, Meliha; Baljic, Rusmir; Hadzic, Amir; Lukovac, Enra; Mehanic, Snjezana; Ahmetspahic-Begic, Aida

    2012-01-01

    SUMMARY CONFLICT OF INTEREST: none declared. Introduction Varicella or chickenpox is highly contagious, childhood infectious disease caused by primary infection with varicellazoster virus from the herpes family of viruses. Usually it has a mild clinical course, rarely with described complication, mostly affecting respiratory tract and rarely the central nervous system. Case report The case present 8 year old boy hospitalized eighth day of disease with clinical pictures of varicella complication. Upon receipt tachydyspnea, high fever, tachycardia, hypotensive with positive findings on lung auscultation in the sense of pneumonia. Extremely high values of non-specific inflammatory parameters are implied on bacterial infection which is treated using triple antimicrobial therapy and antiviral. A detailed clinical, laboratory and radiological evaluation is determined of clinical disease complication under a picture of MODS that required prolonged multidisciplinary treatment in ICU. Conclusion The disease had a favorable clinical outcome in terms of training completely without consequences but, with the detected congenital absence lower lobe of right lung and transposition of the brachiocephalic trunk. PMID:24493991

  12. Herpes zoster on the face in the elderly.

    PubMed

    Nair, Preeti; Gharote, Harshkant; Singh, Pooja; Jain-Choudhary, Palak

    2014-01-01

    Herpes zoster is a localised disease caused by reactivation of the varicella zoster virus that enters the cutaneous nerve endings during an earlier episode of chicken pox, travels to the dorsal root ganglia, and remains in latent form. The condition is characterised by occurrence of multiple, painful, unilateral vesicles and ulceration, and shows a typical single dermatome innervated by single dorsal root or cranial sensory ganglion. Involvement of three or more dermatomes is known as disseminated zoster and seen in immunocompromised individuals. Complications of herpes zoster include ocular sequelae, bacterial superinfection of the lesions, meningoencephalitis and postherpetic neuralgia. The incidence of herpes zoster increases with age and immunosuppression, therefore prompt management is necessary to avoid morbidity and mortality in these individuals. We present two case reports of herpes zoster, one involving the maxillary and mandibular branches of the trigeminal nerve while the other involves all branches of the trigeminal nerve. PMID:25331144

  13. Rare Occurrence of Herpes Zoster of Trigeminal Nerve following Extraction of Tooth

    PubMed Central

    Christy, A. Winnifred; Raja Deva Thanmbi, T. Jones; Leelavathy, J.; Rhema Louis, Antoinette

    2015-01-01

    Herpes Zoster also known as Shingles is an acute viral infection which is an extremely painful and incapacitating ailment. It results from the reactivation of the varicella zoster virus. The triggering factors for the onset of an attack of Herpes Zoster include some form of immunosuppression. The diagnosis of Herpes Zoster can be made on proper medical history and a thorough clinical examination. Here is the report of a male patient affected by Herpes Zoster infection which followed after extraction of a lower first molar. PMID:26819783

  14. Herpes Zoster Duplex Bilateralis in Immuno-Competent Patients: Report of Two Cases

    PubMed Central

    Dalela, Gaurav

    2015-01-01

    Herpes Zoster is a common viral disorder, occurs due to reactivation of latent Varicella Zoster Virus (VZV) usually in adults or elderly patients, usually confined to a single dermatome. Herpes zoster duplex is a rare but well established entity which is simultaneous, occurring of herpes zoster at two different non contiguous dermatomes, can be unilateralis or bilateralis. Here we are reporting two cases of herpes zoster duplex bilateralis, in case-1 lesions occurs in two different distant dermatomes while in case-2 it appeared in a single dermatome but both sides were involved. Both the patients were healthy immuno-competent male. PMID:26816979

  15. Blindness resulting from orbital complications of ophthalmic zoster.

    PubMed

    Moniuszko, Anna; Sosnowska, Magdalena; Zajkowska, Agata; Garkowski, Adam; Czupryna, Piotr; Pancewicz, Sławomir; Zajkowska, Joanna

    2015-10-01

    Herpes zoster ophthalmicus occurs when the latent varicella zoster virus (VZV) reactivates in the trigeminal ganglion and ophthalmic branch of the trigeminal nerve. In the elderly, there is a sharp increase in the tendency of secondary skin bacterial infections occurrence due to the deterioration of capabilities of self-care and changed sanitation. We present a case of patient who developed phlegmon of the orbit, which resulted with complete unilateral blindness. Varicella zoster virus infection in the elderly may have a severe course due to the progressive weakening of the immune system related to the age. Moreover, skin lesions around the eye socket require special care in prevention of bacterial superinfections due to the extremely high risk of life-threatening complications or disability. Neuralgia resistant to pharmacological treatment present in the course of ophthalmic zoster and difficulty in caring about skin lesions predispose to the occurrence of complications. PMID:26759550

  16. Blindness resulting from orbital complications of ophthalmic zoster

    PubMed Central

    Sosnowska, Magdalena; Zajkowska, Agata; Garkowski, Adam; Czupryna, Piotr; Pancewicz, Sławomir; Zajkowska, Joanna

    2015-01-01

    Herpes zoster ophthalmicus occurs when the latent varicella zoster virus (VZV) reactivates in the trigeminal ganglion and ophthalmic branch of the trigeminal nerve. In the elderly, there is a sharp increase in the tendency of secondary skin bacterial infections occurrence due to the deterioration of capabilities of self-care and changed sanitation. We present a case of patient who developed phlegmon of the orbit, which resulted with complete unilateral blindness. Varicella zoster virus infection in the elderly may have a severe course due to the progressive weakening of the immune system related to the age. Moreover, skin lesions around the eye socket require special care in prevention of bacterial superinfections due to the extremely high risk of life-threatening complications or disability. Neuralgia resistant to pharmacological treatment present in the course of ophthalmic zoster and difficulty in caring about skin lesions predispose to the occurrence of complications. PMID:26759550

  17. [Varicella vaccination: who should be vaccinated these days?].

    PubMed

    Hügle, Boris; Suchowerskyj, Philipp; Schuster, Volker

    2005-02-24

    In July 2004 the STIKO (German National Commission for Vaccinations) recommended routine varicella vaccination (together with the first MMR vaccination) for all healthy infants. The previous recommendations for vaccination of adolescents with no history of varicella and patient groups at risk remain valid. In persons with severely depressed cellular immunity or pregnant women vaccination with live attenuated VZV vaccines is contraindicated. Experience gained in the United States show that widespread introduction of VZV vaccination results in a decrease in both the incidence of varicella and concomitant complications including herpes zoster. PMID:18441563

  18. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report

    PubMed Central

    Hariharan, Krishnamoorthy; Pillai, Biju S.; Bansal, Devesh

    2016-01-01

    Herpes zoster is a reactivated varicella-zoster virus (VZV) infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL) can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient. PMID:27555686

  19. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report.

    PubMed

    Hariharan, Krishnamoorthy; Pillai, Biju S; Bansal, Devesh

    2016-01-01

    Herpes zoster is a reactivated varicella-zoster virus (VZV) infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL) can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient. PMID:27555686

  20. [Herpes zoster in the pharynx].

    PubMed

    Sipari, Sini; Koivula, Irma; Löppönen, Heikki

    2016-01-01

    A 74-year-old woman was suspected of having a peritonsillar abscess. She had a light-coloured coating on the pharynx and the larynx, bordering to the left of the median line, as well as laryngeal edema on the side of the lesion. On the basis of precisely unilateral findings we arrived at pharyngeal herpes zoster as the working diagnosis. The diagnosis was further supported by the detection of varicella-zoster virus DNA in the mucosa and the presence of positive IgM antibody levels. The patient was treated with an antiviral drug, an antimicrobial drug and a glucocorticoid. Mucosal lesions and edema returned to normal, and the patient was discharged. The precise unilaterality of the symptoms is essential to the diagnosis. PMID:27244933

  1. Vaccine-associated herpes zoster ophthalmicus [correction of opthalmicus] and encephalitis in an immunocompetent child.

    PubMed

    Chouliaras, Giorgos; Spoulou, Vana; Quinlivan, Mark; Breuer, Judith; Theodoridou, Maria

    2010-04-01

    Varicella-zoster virus vaccine has diminished the consequences of chicken pox in terms of health and economical burden. The increasing number of doses administered worldwide has revealed rare but important adverse effects that had not occurred during clinical trials. We report here the case of an immunocompetent 3(1/2)-year-old girl who developed encephalitis and herpes zoster opthalmicus 20 months after her immunization with varicella-zoster virus vaccine. Molecular analysis confirmed the vaccine strain as the causative agent. After an intravenous course with acyclovir, the child made a full recovery with no neurologic sequelae. PMID:20194287

  2. Herpes zoster: diagnostic, therapeutic, and preventive approaches.

    PubMed

    Bader, Mazen S

    2013-09-01

    Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pregabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz. PMID:24113666

  3. Varicella infection modeling.

    SciTech Connect

    Jones, Katherine A.; Finley, Patrick D.; Moore, Thomas W.; Nozick, Linda Karen; Martin, Nathaniel; Bandlow, Alisa; Detry, Richard Joseph; Evans, Leland B.; Berger, Taylor Eugen

    2013-09-01

    Infectious diseases can spread rapidly through healthcare facilities, resulting in widespread illness among vulnerable patients. Computational models of disease spread are useful for evaluating mitigation strategies under different scenarios. This report describes two infectious disease models built for the US Department of Veteran Affairs (VA) motivated by a Varicella outbreak in a VA facility. The first model simulates disease spread within a notional contact network representing staff and patients. Several interventions, along with initial infection counts and intervention delay, were evaluated for effectiveness at preventing disease spread. The second model adds staff categories, location, scheduling, and variable contact rates to improve resolution. This model achieved more accurate infection counts and enabled a more rigorous evaluation of comparative effectiveness of interventions.

  4. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP).

    PubMed

    Harpaz, Rafael; Ortega-Sanchez, Ismael R; Seward, Jane F

    2008-06-01

    These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of a live attenuated vaccine for the prevention of herpes zoster (zoster) (i.e., shingles) and its sequelae, which was licensed by the U.S. Food and Drug Administration (FDA) on May 25, 2006. This report summarizes the epidemiology of zoster and its sequelae, describes the zoster vaccine, and provides recommendations for its use among adults aged > or =60 years in the United States. Zoster is a localized, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromised persons. It is caused by reactivation of latent varicella zoster virus (VZV) decades after initial VZV infection is established. Approximately one in three persons will develop zoster during their lifetime, resulting in an estimated 1 million episodes in the United States annually. A common complication of zoster is postherpetic neuralgia (PHN), a chronic, often debilitating pain condition that can last months or even years. The risk for PHN in patients with zoster is 10%-18%. Another complication of zoster is eye involvement, which occurs in 10%-25% of zoster episodes and can result in prolonged or permanent pain, facial scarring, and loss of vision. Approximately 3% of patients with zoster are hospitalized; many of these episodes involved persons with one or more immunocompromising conditions. Deaths attributable to zoster are uncommon among persons who are not immunocompromised. Prompt treatment with the oral antiviral agents acyclovir, valacyclovir, and famciclovir decreases the severity and duration of acute pain from zoster. Additional pain control can be achieved in certain patients by supplementing antiviral agents with corticosteroids and with analgesics. Established PHN can be managed in certain patients with analgesics, tricyclic antidepressants, and other agents. Licensed zoster vaccine is a lyophilized preparation of a live

  5. Development of varicella vaccine in Japan and future prospects.

    PubMed

    Ozaki, Takao; Asano, Yoshizo

    2016-06-17

    In Japan, Dr. Michiaki Takahashi (1928-2013) successfully developed the first live attenuated varicella vaccine in the world. The virus used for this vaccine was varicella-zoster virus isolated from the vesicular fluid of a child with typical varicella and it was named the Oka strain after the family name of the child. In 1974, a patient with nephrosis developed varicella in the Pediatric Ward, and uninfected pediatric patients received varicella vaccine immediately. As a result, there were no cases of varicella in the other children and all of the vaccinated children acquired immunity to the disease. These results were published in the Lancet, demonstrating the safety and efficacy of varicella Oka strain vaccine for the first time. When clinical studies were conducted at the start of vaccine development, most of the subjects were pediatric patients with a high risk of contracting severe varicella. Therefore, the development process was different from that for other vaccines, since clinical studies are generally performed in healthy individuals. This vaccine was approved in Japan in 1986, and voluntary single-dose vaccination for children aged 1 year or older was started in 1987. However, the vaccination coverage rate remained low and the number of patients with varicella did not decrease significantly. Due to its voluntary status, the cost of vaccination was borne by the child's family and this was considered to be a reason for the low coverage rate. Moreover, although the vaccine achieved a good antibody response, the number of cases of breakthrough varicella (BV) was relatively high and showed an increasing trend that was also a concern. In order to increase the coverage rate and reduce BV, the Japanese government changed the varicella vaccination policy from voluntary to routine vaccination in October 2014. At the same time, a two-dose schedule was introduced that involved administration of the vaccine twice at an interval of at least 3 months up to the age of

  6. Acute hemiplegia with lacunar infarct after varicella infection in childhood.

    PubMed

    Eda, I; Takashima, S; Takeshita, K

    1983-01-01

    We report 4 cases of acute hemiplegia and a small low-density lesion on computerized tomography (CT) after varicella infection. In 3 of them, CT in the acute hemiplegic stage, and later, reveals the development of lacunar infarct around the internal capsule. Focal low density may be caused by occlusive vascular lesions of the penetrating arteries. Varicella infection may play an important role as one of the causes of acute hemiplegia in childhood producing lacunar infarct, as well as delayed hemiplegia, reported previously in herpes zoster ophthalmicus. PMID:6660422

  7. Zoster in children with cancer: radioimmune precipitation profiles of sera before and after illness.

    PubMed

    Grose, C

    1983-01-01

    Sera collected from children with cancer before and for extended periods after the onset of zoster were analyzed by radioimmune precipitation techniques. The percent recovery of both [3H]fucose- and [35S]methionine-labeled varicella-zoster virus (VZV)-specific antigens increased severalfold immediately after zoster and declined slowly during convalescence; however, within two years serum panels from two patients exhibited serologic evidence of subclinical reactivation of VZV. After electrophoretic fractionation of the immunoprecipitates, the polypeptide profile after zoster closely resembled that described for high titer xenoantisera to VZV and contained at least 16 constituents ranging in molecular weight from 32 to 174,000. In contrast, sera obtained before zoster were easily distinguished because they precipitated poorly, if at all, two major VZV glycoproteins (gp62 and gp98) and several nonglycosylated polypeptides. The emergence of zoster, therefore, was associated with the appearance of previously undetectable antibodies to VZV-specific proteins. PMID:6296242

  8. The simian varicella virus uracil DNA glycosylase and dUTPase genes are expressed in vivo, but are non-essential for replication in cell culture

    PubMed Central

    Ward, Toby M.; Williams, Marshall V.; Traina-Dorge, Vicki; Gray, Wayne L.

    2012-01-01

    Neurotropic herpesviruses express viral deoxyuridine triphosphate nucleotidohydrolase (dUTPase) and uracil DNA glycosylase (UDG) enzymes which may reduce uracil misincorporation into viral DNA, particularly in neurons of infected ganglia. The simian varicella virus (SVV) dUTPase (ORF 8) and UDG (ORF 59) share 37.7% and 53.9% amino acid identity, respectively, with varicella-zoster virus (VZV) homologs. Infectious SVV mutants defective in either dUTPase (SVV-dUTPase−) or UDG (SVV-UDG−) activity or both (SVV-dUTPase−/UDG−) were constructed using recA assisted endonuclease cleavage (RARE) and a cosmid recombination system. Loss of viral dUTPase and UDG enzymatic activity was confirmed in CV-1 cells infected with the SVV mutants. The SVV-dUTPase−, SVV-UDG−, and SVV-dUTPase−/UDG− mutants replicated as efficiently as wild-type SVV in cell culture. SVV dUTPase and UDG expression was detected in tissues derived from acutely infected animals, but not in tissues derived from latently infected animals. Further studies will evaluate the pathogenesis of SVV dUTPase and UDG mutants and their potential as varicella vaccines. PMID:19200445

  9. Simian varicella virus reactivation in cynomolgus monkeys

    SciTech Connect

    Mahalingam, Ravi Traina-Dorge, Vicki Wellish, Mary Lorino, Rebecca Sanford, Robert Ribka, Erin P. Alleman, Scott J. Brazeau, Elizabeth Gilden, Donald H.

    2007-11-10

    SVV infection of primates closely resembles VZV infection of humans. Like VZV, SVV becomes latent in ganglionic neurons. We used this model to study the effect of immunosuppression on varicella reactivation. Cynomolgus monkeys latently infected with SVV were irradiated and treated with tacrolimus and prednisone. Of four latently infected monkeys that were immunosuppressed and subjected to the stress of transportation and isolation, one developed zoster, and three others developed features of subclinical reactivation. Another non-immunosuppressed latently infected monkey that was subjected to the same stress of travel and isolation showed features of subclinical reactivation. Virus reactivation was confirmed not only by the occurrence of zoster in one monkey, but also by the presence of late SVV RNA in ganglia, and the detection of SVV DNA in non-ganglionic tissue, and SVV antigens in skin, ganglia and lung.

  10. A case of herpes zoster associated with colitis.

    PubMed

    Okimura, H; Muto, M; Ichimiya, M; Mogami, S; Takahata, H; Asagami, C

    1996-09-01

    A 58-year-old Japanese woman who had herpes zoster in association with colitis was successfully treated with intravenously administrated acyclovir. Vesicular lesions with red haloes ranged from the left side of her buttock to the left extremity, corresponding to the L4 to S2 dermatomes. Her colitis was considered to have been induced by varicella-zoster virus, based on the facts that the clinical courses were correlated and that the innervation of the affected site of the colon corresponded to an infected dermatome (S2). PMID:8916665

  11. Risk Factors for Herpes Zoster Among Adults.

    PubMed

    Marin, Mona; Harpaz, Rafael; Zhang, John; Wollan, Peter C; Bialek, Stephanie R; Yawn, Barbara P

    2016-09-01

    Background.  The causes of varicella-zoster virus reactivation and herpes zoster (HZ) are largely unknown. We assessed potential risk factors for HZ, the data for which cannot be obtained from the medical sector. Methods.  We conducted a matched case-control study. We established active surveillance in Olmsted County, Minnesota to identify HZ occurring among persons age ≥50 years during 2010-2011. Cases were confirmed by medical record review. Herpes zoster-free controls were age- and sex-matched to cases. Risk factor data were obtained by telephone interview. Results.  We enrolled 389 HZ case patients and 511 matched controls; the median age was 65 and 66 years, respectively. Herpes zoster was associated with family history of HZ (adjusted odds ratio [aOR] = 1.65); association was highest with first-degree or multiple relatives (aOR = 1.87 and 3.08, respectively). Herpes zoster was also associated with prior HZ episodes (aOR = 1.82), sleep disturbance (aOR = 2.52), depression (aOR = 3.81), and recent weight loss (aOR = 1.95). Stress was a risk factor for HZ (aOR = 2.80), whereas a dose-response relationship was not noted. All associations indicated were statistically significant (P < .05). Herpes zoster was not associated with trauma, smoking, tonsillectomy, diet, or reported exposure to pesticides or herbicides (P > .1). Conclusions.  We identified several important risk factors for HZ; however, the key attributable causes of HZ remain unknown. PMID:27382600

  12. Risk Factors for Herpes Zoster Among Adults

    PubMed Central

    Marin, Mona; Harpaz, Rafael; Zhang, John; Wollan, Peter C.; Bialek, Stephanie R.; Yawn, Barbara P.

    2016-01-01

    Background. The causes of varicella-zoster virus reactivation and herpes zoster (HZ) are largely unknown. We assessed potential risk factors for HZ, the data for which cannot be obtained from the medical sector. Methods. We conducted a matched case-control study. We established active surveillance in Olmsted County, Minnesota to identify HZ occurring among persons age ≥50 years during 2010–2011. Cases were confirmed by medical record review. Herpes zoster-free controls were age- and sex-matched to cases. Risk factor data were obtained by telephone interview. Results. We enrolled 389 HZ case patients and 511 matched controls; the median age was 65 and 66 years, respectively. Herpes zoster was associated with family history of HZ (adjusted odds ratio [aOR] = 1.65); association was highest with first-degree or multiple relatives (aOR = 1.87 and 3.08, respectively). Herpes zoster was also associated with prior HZ episodes (aOR = 1.82), sleep disturbance (aOR = 2.52), depression (aOR = 3.81), and recent weight loss (aOR = 1.95). Stress was a risk factor for HZ (aOR = 2.80), whereas a dose-response relationship was not noted. All associations indicated were statistically significant (P < .05). Herpes zoster was not associated with trauma, smoking, tonsillectomy, diet, or reported exposure to pesticides or herbicides (P > .1). Conclusions. We identified several important risk factors for HZ; however, the key attributable causes of HZ remain unknown. PMID:27382600

  13. Challenges with controlling varicella in prison settings: experience of California, 2010 to 2011.

    PubMed

    Leung, Jessica; Lopez, Adriana S; Tootell, Elena; Baumrind, Nikki; Mohle-Boetani, Janet; Leistikow, Bruce; Harriman, Kathleen H; Preas, Christopher P; Cosentino, Giorgio; Bialek, Stephanie R; Marin, Mona

    2014-10-01

    This article describes the epidemiology of varicella in one state prison in California during 2010 and 2011, control measures implemented, and associated costs. Eleven varicella cases were reported, of which nine were associated with two outbreaks. One outbreak consisted of three cases and the second consisted of six cases with two generations of spread. Among exposed inmates serologically tested, 98% (643/656) were varicella-zoster virus seropositive. The outbreaks resulted in > 1,000 inmates exposed, 444 staff exposures, and > $160,000 in costs. The authors documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary to manage cases and outbreaks. PMID:25201912

  14. β-L-1-[5-(E-2-Bromovinyl)-2-(hydroxymethyl)-1,3-(dioxolan-4-yl)] uracil (L-BHDU) prevents varicella-zoster virus replication in a SCID-Hu mouse model and does not interfere with 5-fluorouracil catabolism

    PubMed Central

    De, Chandrav; Liu, Dongmei; Zheng, Bo; Singh, Uma S.; Chavre, Satish; White, Catherine; Arnold, Robert D.; Hagen, Fred K.; Chu, Chung K.; Moffat, Jennifer F.

    2014-01-01

    The alphaherpesvirus varicella-zoster virus (VZV) causes chickenpox and shingles. Current treatments are acyclovir (ACV) and its derivatives, foscarnet and brivudine (BVdU). Additional antiviral compounds with increased potency and specificity are needed to treat VZV, especially to treat post-herpetic neuralgia. We evaluated β-L-1-[5-(E-2-Bromovinyl)-2-(hydroxymethyl)-1,3-(dioxolan-4-yl)] uracil (L-BHDU, 1) and 5′-O-valyl-L-BHDU (2) in three models of VZV replication: primary human foreskin fibroblasts (HFFs), skin organ culture (SOC) and in SCID-Hu mice with skin xenografts. The efficacy of L-BHDU in vivo and its drug-drug interactions were previously not known. In HFFs, 200 μM L-BHDU was noncytotoxic over 3 days, and L-BHDU treatment reduced VZV genome copy number and cell to cell spread. The EC50 in HFFs for L-BHDU and valyl-L-BHDU were 0.22 and 0.03 μM, respectively. However, L-BHDU antagonized the activity of ACV, BVdU and foscarnet in cultured cells. Given its similar structure to BVdU, we asked if L-BHDU, like BVdU, inhibits 5-fluorouracil catabolism. BALB/c mice were treated with 5-FU alone or in combination with L-BHDU or BVdU. L-BHDU did not interfere with 5-FU catabolism. In SCID-Hu mice implanted with human skin xenografts, L-BHDU and valyl-L-BHDU were superior to ACV and valacyclovir. The maximum concentration (Cmax) levels of L-BHDU were determined in mouse and human tissues at 2 h after dosing, and comparison of concentration ratios of tissue to plasma indicated saturation of uptake at the highest dose. For the first time, an L-nucleoside analog, L-BHDU, was found to be effective and well tolerated in mice. PMID:25051026

  15. β-l-1-[5-(E-2-bromovinyl)-2-(hydroxymethyl)-1,3-(dioxolan-4-yl)] uracil (l-BHDU) prevents varicella-zoster virus replication in a SCID-Hu mouse model and does not interfere with 5-fluorouracil catabolism.

    PubMed

    De, Chandrav; Liu, Dongmei; Zheng, Bo; Singh, Uma S; Chavre, Satish; White, Catherine; Arnold, Robert D; Hagen, Fred K; Chu, Chung K; Moffat, Jennifer F

    2014-10-01

    The alphaherpesvirus varicella-zoster virus (VZV) causes chickenpox and shingles. Current treatments are acyclovir (ACV) and its derivatives, foscarnet and brivudine (BVdU). Additional antiviral compounds with increased potency and specificity are needed to treat VZV, especially to treat post-herpetic neuralgia. We evaluated β-l-1-[5-(E-2-bromovinyl)-2-(hydroxymethyl)-1,3-(dioxolan-4-yl)] uracil (l-BHDU, 1) and 5'-O-valyl-l-BHDU (2) in three models of VZV replication: primary human foreskin fibroblasts (HFFs), skin organ culture (SOC) and in SCID-Hu mice with skin xenografts. The efficacy of l-BHDU in vivo and its drug-drug interactions were previously not known. In HFFs, 200μM l-BHDU was noncytotoxic over 3days, and l-BHDU treatment reduced VZV genome copy number and cell to cell spread. The EC50 in HFFs for l-BHDU and valyl-l-BHDU were 0.22 and 0.03μM, respectively. However, l-BHDU antagonized the activity of ACV, BVdU and foscarnet in cultured cells. Given its similar structure to BVdU, we asked if l-BHDU, like BVdU, inhibits 5-fluorouracil catabolism. BALB/c mice were treated with 5-FU alone or in combination with l-BHDU or BVdU. l-BHDU did not interfere with 5-FU catabolism. In SCID-Hu mice implanted with human skin xenografts, l-BHDU and valyl-l-BHDU were superior to ACV and valacyclovir. The maximum concentration (Cmax) levels of l-BHDU were determined in mouse and human tissues at 2h after dosing, and comparison of concentration ratios of tissue to plasma indicated saturation of uptake at the highest dose. For the first time, an l-nucleoside analog, l-BHDU, was found to be effective and well tolerated in mice. PMID:25051026

  16. Zoster ... "a lmost" ... sine herpete: diagnostic utility of real time-polymerase chain reaction.

    PubMed

    Vena, Gino A; Apruzzi, Doriana; Vestita, Michelangelo; Calvario, Agata; Foti, Caterina; Cassano, Nicoletta

    2010-10-01

    Zoster sine herpete is a particular form of varicella zoster virus (VZV) infection characterized by segmental pain and dysesthesia, without any cutaneous lesions ever becoming perceptible. This report describes the case of a female patient, presenting with intercostal pain associated with a single papulo-vesicular lesion localized within the same area. Thanks to such a lesion, real time-polymerase chain reaction (PCR) analysis on vesicle fluid swab was possible, thus revealing a significant number of VZV genome copies. This innovative tool has proven essential to diagnose this abortive form of herpes zoster, which would otherwise have remained unidentified. PMID:21213602

  17. A Case of Peri-Anal Varicella and Review of the Literature

    ERIC Educational Resources Information Center

    Barrett, Sabrina; Burgess, Scott

    2011-01-01

    Grouped vesicle on an erythematous base suggests a herpes virus infection and located within the anogenital region raises the possibility of sexual assault. The following case and review highlight the need to consider infection by varicella zoster virus in such cases and emphasises the importance of a prompt and accurate diagnosis.

  18. Varicella outbreaks in Army recruits from Puerto Rico. Varicella susceptibility in a population from the tropics.

    PubMed

    Longfield, J N; Winn, R E; Gibson, R L; Juchau, S V; Hoffman, P V

    1990-05-01

    Two outbreaks of varicella consisting of a total of 105 cases occurred in a highly varicella-susceptible population of young adult Army recruits from Puerto Rico enrolled in the Defense Language Institute in San Antonio, Tex, between October 1986 and November 1987. Epidemiologic investigation found a significantly higher risk for enlisted recruits housed in open barracks than for officers housed in private rooms. The attack rate in the first outbreak was 30%, with an estimated attack rate of 71% among susceptible persons. Serologic testing of 810 adult recruits from Puerto Rico for varicella-zoster antibody by means of an enzyme-linked immunosorbent assay procedure found 42% to be seronegative, with no significant difference by sex. The enzyme-linked immunosorbent assay test had a positive predictive value for absence of disease development of 95% in the second outbreak. Serologic test results were successfully used as part of the outbreak control strategy, with a resultant decrease in attack rates to 19% overall and 30% among susceptible persons in the second outbreak. Uniquely susceptible adult populations placed in conditions with high likelihood of infection on exposure are potential candidates for the varicella vaccine after its licensure. PMID:2158774

  19. Recombinant varicella vaccines induce neutralizing antibodies and cellular immune responses to SIV and reduce viral loads in immunized rhesus macaques

    PubMed Central

    Traina-Dorge, V.; Pahar, B.; Marx, P.; Kissinger, P.; Montefiori, D.; Ou, Y.; Gray, W.L.

    2010-01-01

    The development of an effective AIDS vaccine remains one of the highest priorities in HIV research. The live, attenuated varicella-zoster virus (VZV) Oka vaccine, safe and effective for prevention of chickenpox and zoster, also has potential as a recombinant vaccine against other pathogens, including human immunodeficiency virus (HIV). The simian varicella model, utilizing simian varicella virus (SVV), offers an approach to evaluate recombinant varicella vaccine candidates. Recombinant SVV (rSVV) vaccine viruses expressing simian immunodeficiency virus (SIV) env and gag antigens were constructed. The hypothesis tested was that a live, attenuated rSVV-SIV vaccine will induce immune responses against SIV in the rhesus macaques and provide protection against SIV challenge. The results demonstrated that rSVV-SIV vaccination induced low levels of neutralizing antibodies and cellular immune responses to SIV in immunized rhesus macaques and significantly reduced viral loads following intravenous challenge with pathogenic SIVmac251-CX-1. PMID:20654666

  20. Clinical benefits of routine varicella vaccination for adults.

    PubMed

    Germinario, Cinzia; Gallone, Maria Serena; Cappelli, Maria Giovanna; Tafuri, Silvio

    2015-01-01

    Varicella is a highly contagious disease caused by varicella zoster virus. In children, it is generally a mild to moderate illness while it is often more severe in adults, with serious complications as dehydration, pneumonia, bleeding problems, infection or inflammation of the brain, secondary bacterial infections, sepsis, toxic shock syndrome, bone infections, joint infections and deaths. Some groups of adults are at major risk of complications, in particular immunocompromised persons as subjects with impaired humoral immunity and who is receiving systemic steroids, persons who live or work in environments in which transmission of varicella is likely, health-care personnel and pregnant women. After the introduction of Universal Mass Vaccination (UMV), the first mathematical models suggested that vaccination will lead to a shift in the average age at infection from children to adults with an increasing numbers of complicated forms, nevertheless new models predicted that, although an upward shift in the age at infection may occur, the overall morbidity due to varicella is likely to decrease. Current literature seems to suggest that for public health authorities the key action to prevent an increase of varicella incidence among adults is to achieve high vaccination coverage among babies and adolescents in countries who adopted UMV. PMID:25970524

  1. Clinical benefits of routine varicella vaccination for adults

    PubMed Central

    Germinario, Cinzia; Gallone, Maria Serena; Cappelli, Maria Giovanna; Tafuri, Silvio

    2015-01-01

    Varicella is a highly contagious disease caused by varicella zoster virus. In children, it is generally a mild to moderate illness while it is often more severe in adults, with serious complications as dehydration, pneumonia, bleeding problems, infection or inflammation of the brain, secondary bacterial infections, sepsis, toxic shock syndrome, bone infections, joint infections and deaths. Some groups of adults are at major risk of complications, in particular immunocompromised persons as subjects with impaired humoral immunity and who is receiving systemic steroids, persons who live or work in environments in which transmission of varicella is likely, health-care personnel and pregnant women. After the introduction of Universal Mass Vaccination (UMV), the first mathematical models suggested that vaccination will lead to a shift in the average age at infection from children to adults with an increasing numbers of complicated forms, nevertheless new models predicted that, although an upward shift in the age at infection may occur, the overall morbidity due to varicella is likely to decrease. Current literature seems to suggest that for public health authorities the key action to prevent an increase of varicella incidence among adults is to achieve high vaccination coverage among babies and adolescents in countries who adopted UMV. PMID:25970524

  2. Herpes Zoster (Shingles) and Postherpetic Neuralgia

    PubMed Central

    Sampathkumar, Priya; Drage, Lisa A.; Martin, David P.

    2009-01-01

    Herpes zoster (HZ), commonly called shingles, is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). This reactivation occurs when immunity to VZV declines because of aging or immunosuppression. Herpes zoster can occur at any age but most commonly affects the elderly population. Postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of HZ. The diagnosis of HZ is usually made clinically on the basis of the characteristic appearance of the rash. Early recognition and treatment can reduce acute symptoms and may also reduce PHN. A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is now available and is recommended for adults older than 60 years. The vaccine has been shown to reduce significantly the incidence of both HZ and PHN. The vaccine is well tolerated, with minor local injection site reactions being the most common adverse event. This review focuses on the clinical manifestations and treatment of HZ and PHN, as well as the appropriate use of the HZ vaccine. PMID:19252116

  3. Mandibular osteonecrosis following herpes zoster infection in the mandibular branch of the trigeminal nerve: a case report and literature review

    PubMed Central

    2015-01-01

    Herpes zoster virus (HZV) infections are caused by reactivation of the varicella zoster virus. Reactivation symptoms commonly affect the thoracolumbar trunk, and rarely affect the mandibular branches of the trigeminal nerve. When the mandibular branches are involved, lesions appear proximal to the innervation area. This condition may be associated with exfoliation of the teeth and osteonecrosis of the jawbone. We report a case of mandibular osteomyelitis after herpes zoster infection and we present a review of the literature on mandibular-branch involvement of HZV-related osteonecrosis. PMID:26733193

  4. [Universal vaccination against varicella in Italy: the same opportunity for all children].

    PubMed

    Gabutti, Giovanni; Azzari, Chiara; Bonanni, Paolo; Conversano, Michele; Esposito, Susanna; Prato, Rosa; Russo, Rocco; Tozzi, Alberto Eugenio; Vitali Rosati, Giovanni; Zanetti, Alessandro; Zuccotti, Gianvincenzo; Franco, Elisabetta

    2015-01-01

    Varicella is an infectious disease still frequent in Italy, where 8 out 20 Regions have adopted universal vaccination programs starting from 2003. Accordingly to National Vaccination Plan, all Regions should introduce universal varicella vaccination in 2015. An independent multidisciplinary group of experts met to discuss some debated questions. The available evidence of varicella vaccine efficacy in the 8 Regions was evaluated and the evidence of safety of monovalent and combined varicella vaccines are presented. The strategy for introducing universal varicella vaccine in the pediatric immunization schedule is discussed. The expert group concludes that available evidence supports the active offer of varicella vaccine in all Italian Regions and that catch up programs for susceptible cohorts should be encouraged. PMID:25927654

  5. Chickenpox (Varicella) Complications

    MedlinePlus

    ... for Varicella Complications . Serious complications from chickenpox include bacterial infections of the skin and soft tissues in children including Group A streptococcal infections pneumonia infection or inflammation of the brain (encephalitis, cerebellar ...

  6. Varicella (Chickenpox) Vaccine

    MedlinePlus

    ... vaccine called MMRV, which contains both chickenpox and MMR vaccines, may be given instead of the two individual ... like rash (about 1 person in 20) than MMR and varicella vaccines given separately. Moderate Problems:Seizure (jerking or staring) ...

  7. Clinical Presentation of Herpes Zoster in Immunocompetent and Immunocompromised Hospitalized Children Treated With Acyclovir.

    PubMed

    Kuchar, Ernest; Szenborn, Leszek; Lis, Izabela; Jaroszewska, Anna; Czeladzka, Justyna

    2016-07-01

    Herpes zoster, defined as the reactivation of a latent varicella-zoster virus (VZV) infection, used to be a serious disease in immunocompromised children until recently. The aim of this study was to describe the clinical presentation of herpes zoster in hospitalized immunocompromised children compared with hospitalized immunocompetent counterparts. We reviewed the hospital charts of 72 children aged 6 months to 18 years diagnosed with herpes zoster and treated with acyclovir in our department covering a 19-year period. Forty-six of the children were immunocompromised which was mainly due to hematologic diseases. There were no differences in the age at which herpes zoster occurred, length of hospitalization, and the location or extent of the skin eruption. General symptoms were observed more frequently in the hospitalized immunocompetent patients compared with the hospitalized immunocompromised children (80% vs. 56%). The average age at which primary VZV infection occurred was higher among the immunocompromised children than the immunocompetent children with the latter group suffering from significantly more primary VZV infections during infancy. The presentation of herpes zoster in immunocompromised children is similar to that of herpes zoster in hospitalized immunocompetent children. PMID:27347778

  8. Pathogenesis of infection with varicella vaccine.

    PubMed

    Grose, C

    1996-09-01

    Because of its exanthem, the disease varicella has been known since antiquity. Even late in the 19th century, however, there remained considerable confusion between mild smallpox and chickenpox. The name varicella itself is an irregular diminutive form of variola. Yet, early in the 20th century, detailed histologic studies began to differentiate the exanthems. The investigation of the varicella vesicle by Tyzzer 90 years ago remains a classic example (see Fig. 2). Although the pathogenesis of varicella vaccine virus infection appears to mimic that of wt VZV infection, a vaccine virus-related exanthem is more common in immunized children with an underlying immunosuppressive condition, such as leukemia, than in normal children. Those immunized children who never develop a rash presumably have an abrogated infection in which the host immune response has eliminated the virus prior to a major viremic spread. There may be a correlation between the presence of an exanthem and the ability of an immunized child to spread the varicella vaccine virus. The differences in capsid structure and assembly may explain in part the attenuation of the vaccine strain. Because the majority of varicella vaccine virus particles in the nucleus have aberrant cores lacking an electron-dense center, they are never enveloped. Therefore, they do not become infectious virions. In a recent article, Grose et al applied the technique of three-dimensional (3-D) computer modeling in an attempt to reconstruct an aberrant VZV capsid with the hubcap or pinwheel core. Each 3-D model was then sliced by computer to obtain a series of two-dimensional models that represented the images commonly seen by traditional electron microscopy. The 3-D model that best represented the capsid with a pinwheel core contained particulate matter in each of the 12 vertices of the icosahedral capsid (Fig. 14). This model strongly suggested that VZV may form in the nucleus an intermediary or end-stage capsid with an aberrant

  9. Herpes Zoster Infection Involving Mandibular Division of Trigeminal Nerve and Ramsay Hunt Syndrome with Meningitis in an Immunocompetent Patient: A Rare Association

    PubMed Central

    Ganesan, Vijayan; Kar, Suvrendu Sankar; Choudhury, Cankatika; Choudhary, Vivek

    2016-01-01

    Herpes zoster is a unilateral painful vesicular cutaneous eruption caused by the reactivation of the Varicella zoster virus. It commonly affects the older people and immunocompromised individuals. The dermatomes from T3 to L3 are most frequently involved. Its three stages include prodromal stage, active stage and chronic stage. The common complications of the infection include post-herpetic neuralgia, Ramsay Hunt syndrome, Guillain-Barre syndrome, transverse myelitis and encephalomyelitis. This case report summarizes a very rare association of herpes zoster meningitis with the involvement of mandibular division of the trigeminal nerve and facial nerve. The patient improved with intravenous acyclovir and prednisolone treatment. PMID:27504334

  10. Herpes Zoster Infection Involving Mandibular Division of Trigeminal Nerve and Ramsay Hunt Syndrome with Meningitis in an Immunocompetent Patient: A Rare Association.

    PubMed

    Ganesan, Vijayan; Bandyopadhyay, Dhrubajyoti; Kar, Suvrendu Sankar; Choudhury, Cankatika; Choudhary, Vivek

    2016-06-01

    Herpes zoster is a unilateral painful vesicular cutaneous eruption caused by the reactivation of the Varicella zoster virus. It commonly affects the older people and immunocompromised individuals. The dermatomes from T3 to L3 are most frequently involved. Its three stages include prodromal stage, active stage and chronic stage. The common complications of the infection include post-herpetic neuralgia, Ramsay Hunt syndrome, Guillain-Barre syndrome, transverse myelitis and encephalomyelitis. This case report summarizes a very rare association of herpes zoster meningitis with the involvement of mandibular division of the trigeminal nerve and facial nerve. The patient improved with intravenous acyclovir and prednisolone treatment. PMID:27504334

  11. Polyneuritis and herpes zoster

    PubMed Central

    Dayan, A. D.; Ogul, E.; Graveson, G. S.

    1972-01-01

    Widespread neurological disorders following herpes zoster are exceptional. They include encephalitis and myelitis, and a type of polyneuropathy. The latter is particularly rare as only 16 cases have been described since the first account by Wohlwill in 1924. We present two clinical cases of polyneuropathy following herpes zoster with neuropathological studies on one of them, and discuss its possible aetiology and pathogenesis in the light of previous reports and recent experimental studies. Images PMID:5037030

  12. Herpes zoster (shingles), disseminated (image)

    MedlinePlus

    Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the "dermatome" picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. ...

  13. Varicella (Chickenpox) Vaccine

    MedlinePlus

    Why get vaccinated?Chickenpox (also called varicella) is a common childhood disease. It is usually mild, but it can be serious, especially in ... infection, scars, pneumonia, brain damage, or death. The chickenpox virus can be spread from person to person ...

  14. Infectious Uveitis

    PubMed Central

    2015-01-01

    Infectious uveitis is one of the most common and visually devastating causes of uveitis in the US and worldwide. This review provides a summary of the identification, treatment, and complications associated with certain forms of viral, bacterial, fungal, helminthic, and parasitic uveitis. In particular, this article reviews the literature on identification and treatment of acute retinal necrosis due to herpes simplex virus, varicella virus, and cytomegalovirus. While no agreed-upon treatment has been identified, the characteristics of Ebola virus panuveitis is also reviewed. In addition, forms of parasitic infection such as Toxoplasmosis and Toxocariasis are summarized, as well as spirochetal uveitis. Syphilitic retinitis is reviewed given its increase in prevalence over the last decade. The importance of early identification and treatment of infectious uveitis is emphasized. Early identification can be achieved with a combination of maintaining a high suspicion, recognizing certain clinical features, utilizing multi-modal imaging, and obtaining specimens for molecular diagnostic testing. PMID:26618074

  15. Management and Prevention of Herpes Zoster Ocular Disease.

    PubMed

    Cohen, Elisabeth J

    2015-10-01

    Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus (VZV) in people who have had chicken pox, usually resulting in a painful, unilateral, dermatomal, vesicular rash. Herpes zoster ophthalmicus occurs when the first division of cranial nerve V is involved. HZ is common, with approximately 1 million new cases per year in the United States, and occurs in 1 in 3 persons. Although the rate of HZ increases with age, over half of all cases occur under the age of 60 years. Complications of herpes zoster ophthalmicus include eye disease, postherpetic neuralgia (PHN), and strokes. VZV has also been found in temporal arteritis biopsies. There is growing evidence that HZ is followed by chronic active VZV infection contributing to these complications. In view of this, and the efficacy of suppressive antiviral treatment in reducing recurrent herpes simplex keratitis, a randomized controlled trial of suppressive valacyclovir to reduce new or worsening anterior segment disease and/or PHN is needed. The zoster vaccine (ZV) is safe and effective in reducing the burden of illness, severity of PHN, and incidence of HZ. It is Centers for Disease Control and Prevention recommended for persons aged 60 years and above without impaired cellular immunity, and Food and Drug Administration approved for those aged 50 and older. It is most effective in preventing HZ in recipients in their 50s. Because of underusage of the ZV, it has not impacted the epidemiology of the disease. Barriers to its use include cost, variable reimbursement, frozen storage, and lack of a strong recommendation by doctors. PMID:26114827

  16. Prevalence of infectious pathogens in Crohn's disease.

    PubMed

    Knösel, Thomas; Schewe, Christiane; Petersen, Nanni; Dietel, Manfred; Petersen, Iver

    2009-01-01

    The importance of infectious pathogens in Crohn's disease (CD) is still under debate. Therefore, we examined a panel of potential viral and bacterial pathogens in a large series of CD patients and controls. Archival tissue from 76 patients, 56 with CD and 20 control patients, with normal colon mucosa (n=10) and non-steroid anti-inflammatory drug (NSAID)-induced colitis (n=10) were examined using PCR-based detection methods for human cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus 1, 2 (HSV1,2), adenovirus (AD), varicella-zoster virus (VZV), human herpes virus 6 (HHV6), human herpes virus 8 (HHV8), Mycobacterium tuberculosis complex (Mtbc), atypical mycobacteria (nM/MG1), including Mycobacterium avium (subspecies paratuberculosis, MAP), Stenotrophomonas maltophilia (Sm), and Yersinia enterocolitica (Ye). In CD patients, positive PCR results were achieved in 19 cases (34%). Sm was most frequent in 10 of 56 cases (17.9%) followed by EBV (6/56, 10.7%), nM/MG1 (4/56, 7.1%), including MAP, HHV6, and CMV (2/56, 3.6%), and finally Mtbc and AD (1/56, 1.8%). The control patients showed positive PCR results in 12 patients (12/20, 60%), nine of them with only weak signals, suggesting a persistent infection. In addition, we compared typical pathomorphological features of CD patients with the PCR results and found a significant correlation between EBV infection and mural abscesses (P=0.014). Our data demonstrate that several potential pathogens can be detected in a sizeable fraction of specimens from patients with CD, but also in control patients, suggesting that the analyzed infectious pathogens may be associated with the disease, but do not represent an obligatory cause. PMID:19186006

  17. Infectious Complications during Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Children with High-Risk or Recurrent Solid Tumors.

    PubMed

    Choi, Young Bae; Yi, Eun Sang; Kang, Ji-Man; Lee, Ji Won; Yoo, Keon Hee; Kim, Yae-Jean; Sung, Ki Woong; Koo, Hong Hoe

    2016-01-01

    We retrospectively analyzed infectious complications during tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in children and adolescents with high-risk or recurrent solid tumors. A total of 324 patients underwent their first HDCT/auto-SCT between October 2004 and September 2014, and 283 of them proceeded to their second HDCT/auto-SCT (a total of 607 HDCT/auto-SCTs). During the early transplant period of 607 HDCT/auto-SCTs (from the beginning of HDCT to day 30 post-transplant), bacteremia, urinary tract infection (UTI), respiratory virus infection, and varicella zoster virus (VZV) reactivation occurred in 7.1%, 2.3%, 13.0%, and 2.5% of HDCT/auto-SCTs, respectively. The early transplant period of the second HDCT/auto-SCT had infectious complications similar to the first HDCT/auto-SCT. During the late transplant period of HDCT/auto-SCT (from day 31 to 1 year post-transplant), bacteremia, UTI, and VZV reactivation occurred in 7.5%, 2.5%, and 3.9% of patients, respectively. Most infectious complications in the late transplant period occurred during the first 6 months post-transplant. There were no invasive fungal infections during the study period. Six patients died from infectious complications (4 from bacterial sepsis and 2 from respiratory virus infection). Our study suggests that infectious complications are similar following second and first HDCT/auto-SCT in children. PMID:27627440

  18. Varicella arthritis in a child.

    PubMed Central

    Shuper, A; Mimouni, M; Mukamel, M; Varsano, I

    1980-01-01

    A 2 1/2-year-old girl developed arthritis in a metatarsophalangeal joint concomitantly with varicella. As she recovered within 2 days without antimicrobial treatment, it was considered that the arthritis was directly due to the viral infection. The importance of differentiating viral arthritis from septic arthritis, a well-known complication of varicella, is stressed. PMID:7436508

  19. Varicella susceptibility and transmission dynamics in Slovenia

    PubMed Central

    2010-01-01

    Background A cross-sectional, age-stratified study was conducted to determine varicella-zoster seroprevalence and force of infection in Slovenia. Methods 3689 serum samples were tested for VZV IgG antibodies with an enzyme immunoassay. Semiparametric and parametric modelling were used to estimate the force of infection. Results Overall, 85.6% of serum samples were seropositive. Age-specific prevalence rose rapidly in preschool children and over 90% of 8 years old tested positive for VZV. However, 2.8% of serum samples among women of childbearing age were seronegative. Semiparametric modelling yielded force of infection estimates of 0.182 (95% CI 0.158-0.206), 0.367 (95% CI 0.285-0.448) and 0.008 (95% CI 0.0-0.032) for age groups 0.5- < 6, 6-11 and ≥12 years, respectively, and 0.175 (95% CI 0.147-0.202), 0.391 (95% CI 0.303-0.480) and 0.025 (95% CI 0.003-0.046) for age groups 0.5- < 5, 5-9 and ≥10 years, respectively. Conclusions Regardless of the age grouping used, the highest transmission occurred in children in their first years of school. PMID:20573202

  20. Cytomegalovirus seropositivity is associated with herpes zoster.

    PubMed

    Ogunjimi, Benson; Hens, Niel; Pebody, Richard; Jansens, Hilde; Seale, Holly; Quinlivan, Mark; Theeten, Heidi; Goossens, Herman; Breuer, Judy; Beutels, Philippe

    2015-01-01

    Herpes zoster (HZ) is caused by VZV reactivation that is facilitated by a declined immunity against varicella-zoster virus (VZV), but also occurs in immunocompetent individuals. Cytomegalovirus (CMV) infection is associated with immunosenescence meaning that VZV-specific T-cells could be less responsive. This study aimed to determine whether CMV infection could be a risk factor for the development of HZ. CMV IgG serostatus was determined in stored serum samples from previously prospectively recruited ambulatory adult HZ patients in the UK (N = 223) in order to compare the results with those from UK population samples (N = 1545) by means of a logistic regression (controlling for age and gender). Furthermore, we compared the UK population CMV seroprevalence with those from population samples from other countries (from Belgium (N1 = 1741, N2 = 576), USA (N = 5572) and Australia (N = 2080)). Furthermore, CMV IgG titers could be compared between UK HZ patients and Belgium N2 population samples because the same experimental set-up for analysis was used. We found UK ambulatory HZ patients to have a higher CMV seroprevalence than UK population samples (OR 1.56 [1.11 2.19]). CMV IgG seropositivity was a significant risk factor for HZ in the UK (OR 3.06 [1.32 7.04]. Furthermore, high CMV IgG titers (exceeding the upper threshold) were less abundant in CMV-seropositive Belgian N2 population samples than in CMV-seropositive UK HZ patients (OR 0.51 [0.31 0.82]. We found CMV-seroprevalence to increase faster with age in the UK than in other countries (P < 0.05). We conclude that CMV IgG seropositivity is associated with HZ. This finding could add to the growing list of risk factors for HZ. PMID:25905443

  1. Cytomegalovirus seropositivity is associated with herpes zoster

    PubMed Central

    Ogunjimi, Benson; Hens, Niel; Pebody, Richard; Jansens, Hilde; Seale, Holly; Quinlivan, Mark; Theeten, Heidi; Goossens, Herman; Breuer, Judy; Beutels, Philippe

    2015-01-01

    Herpes zoster (HZ) is caused by VZV reactivation that is facilitated by a declined immunity against varicella-zoster virus (VZV), but also occurs in immunocompetent individuals. Cytomegalovirus (CMV) infection is associated with immunosenescence meaning that VZV-specific T-cells could be less responsive. This study aimed to determine whether CMV infection could be a risk factor for the development of HZ. CMV IgG serostatus was determined in stored serum samples from previously prospectively recruited ambulatory adult HZ patients in the UK (N = 223) in order to compare the results with those from UK population samples (N = 1545) by means of a logistic regression (controlling for age and gender). Furthermore, we compared the UK population CMV seroprevalence with those from population samples from other countries (from Belgium (N1 = 1741, N2 = 576), USA (N = 5572) and Australia (N = 2080)). Furthermore, CMV IgG titers could be compared between UK HZ patients and Belgium N2 population samples because the same experimental set-up for analysis was used. We found UK ambulatory HZ patients to have a higher CMV seroprevalence than UK population samples (OR 1.56 [1.11 2.19]). CMV IgG seropositivity was a significant risk factor for HZ in the UK (OR 3.06 [1.32 7.04]. Furthermore, high CMV IgG titers (exceeding the upper threshold) were less abundant in CMV-seropositive Belgian N2 population samples than in CMV-seropositive UK HZ patients (OR 0.51 [0.31 0.82]. We found CMV-seroprevalence to increase faster with age in the UK than in other countries (P < 0.05). We conclude that CMV IgG seropositivity is associated with HZ. This finding could add to the growing list of risk factors for HZ. PMID:25905443

  2. Genome-wide analysis of T cell responses during acute and latent simian varicella virus infections in rhesus macaques.

    PubMed

    Haberthur, Kristen; Kraft, Aubrey; Arnold, Nicole; Park, Byung; Meyer, Christine; Asquith, Mark; Dewane, Jesse; Messaoudi, Ilhem

    2013-11-01

    Varicella zoster virus (VZV) is the etiological agent of varicella (chickenpox) and herpes zoster (HZ [shingles]). Clinical observations suggest that VZV-specific T cell immunity plays a more critical role than humoral immunity in the prevention of VZV reactivation and development of herpes zoster. Although numerous studies have characterized T cell responses directed against select VZV open reading frames (ORFs), a comprehensive analysis of the T cell response to the entire VZV genome has not yet been conducted. We have recently shown that intrabronchial inoculation of young rhesus macaques with simian varicella virus (SVV), a homolog of VZV, recapitulates the hallmarks of acute and latent VZV infection in humans. In this study, we characterized the specificity of T cell responses during acute and latent SVV infection. Animals generated a robust and broad T cell response directed against both structural and nonstructural viral proteins during acute infection in bronchoalveolar lavage (BAL) fluid and peripheral blood. During latency, T cell responses were detected only in the BAL fluid and were lower and more restricted than those observed during acute infection. Interestingly, we identified a small set of ORFs that were immunogenic during both acute and latent infection in the BAL fluid. Given the close genome relatedness of SVV and VZV, our studies highlight immunogenic ORFs that may be further investigated as potential components of novel VZV vaccines that specifically boost T cell immunity. PMID:23986583

  3. Going Out on a Limb: Do Not Delay Diagnosis of Necrotizing Fasciitis in Varicella Infection.

    PubMed

    Sturgeon, Jonathan P; Segal, Laura; Verma, Anita

    2015-07-01

    Necrotizing fasciitis (NF) is a rare complication of varicella zoster (chicken pox) infection. Its diagnosis can be delayed or missed, which increases mortality and morbidity, because it initially presents similarly to cellulitis. We present the case of a 5-year-old boy who presented with a swollen leg, the difficulties in the diagnosis of NF, and a review of the literature. Necrotizing fasciitis complicating varicella zoster in children is associated with 3.4% mortality, although this rises to 13.6% in streptococcal toxic shock syndrome. Seventy-one percent of cases are confirmed as being caused by group A β-hemolytic Streptococcus. The association of NF with chicken pox is discussed along with the difficulties in diagnosis and treatment options. Necrotizing fasciitis is a surgical emergency and should be considered by all emergency department acute care practitioners in cases of varicella in which fever is enduring and swelling or pain is disproportionate. Because of the difficulty in diagnosis, senior opinion should be sought early. PMID:25356828

  4. Travelers' Health: Varicella (Chickenpox)

    MedlinePlus

    ... Global TravEpiNet Mobile Apps RSS Feeds Chapter 3 Infectious Diseases Related to Travel Recommend on Facebook Tweet Share ... Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy ...

  5. [Herpes zoster in immunocompetent pregnant women and their perinatal outcome].

    PubMed

    Casanova Román, Gerardo; Reyna Figueroa, Jesús; Figueroa Damián, Ricardo; Ortiz Ibarra, Javier

    2004-02-01

    A prospective and descriptive study was done in pregnant women diagnosed with herpes zoster, to know the demographic characteristics and clinical manifestations as well as maternal and/or neonatal complications to cause by this viral infection during pregnancy. The study included all pregnant women diagnosed with herpes zoster at the Department of Infectious Diseases of the Instituto Nacional de Perinatologia México, between 1994 and 2002. A total of 17 women were included in the study. All were given clinical and ultrasound follow-up to discard any maternal or fetal complications also at the moment of birth. A review in the newborn was made to establish the demographic, anthropometric and clinical characteristics; also the data collected included mother's age, gestational age at the moment of diagnosis with herpes zoster, anatomical lesion site, treatments administered, ultrasound characteristics, newborn's gestational age, weight, height, Apgar at birth and type of delivery. The most frequent site (58.8%) for herpes zoster lesions on the mother was the intercostal area, followed by the scapular region, the lumbar region and the limbs. None of the patients experienced complications during pregnancy, including post-herpetic pain. Sixteen of the newborns had no complications and one was a stillborn due to 60% of placental separation. These findings suggest a benign evolution of herpes zoster during pregnancy, supporting similar findings in the literature. No complications during pregnancy are suggested, and no phenotypical alterations occurred in the child at the moment of birth. PMID:15216903

  6. Mandibular osteonecrosis and Ramsay Hunt syndrome following a case of herpes zoster.

    PubMed

    Rudd, Travis; Chai, Bryan Y; Gurunluoglu, Raffi; Glasgow, Mark

    2014-10-01

    Varicella zoster virus (VZV) is the agent that causes chicken pox, a common childhood infection that characteristically presents as vesicular rashes affecting the trunk and head. After the primary infection has resolved, VZV lies dormant in the spinal dorsal root ganglia or extramedullary cranial nerve ganglia until reactivation results in herpes zoster (shingles). The sensory nerves of the trunk, as in classic shingles, and the fifth cranial nerve, as in trigeminal zoster, are the most frequently affected. Shingles is an acute viral infection characterized by the appearance of painful unilateral vesicular rash usually restricted to a dermatomal distribution of a sensory nerve. The rash of shingles is usually preceded by pain and paresthesia. A rare, severe complication of the reactivation of VZV in the geniculate ganglion of the facial nerve is Ramsay Hunt syndrome (RHS). RHS is characterized by otalgia, vesicles in the auditory canal, and ipsilateral facial paralysis. An even rarer complication of VZV infection includes post-zoster osteonecrosis. This report documents a case of severe mandibular osteonecrosis and RHS after an outbreak of herpes zoster and treatment strategies. PMID:25234535

  7. Herpes Zoster Induced Osteomyelitis in the Immunocompromised Patients: A 10-year Multicenter Study

    PubMed Central

    Tabrizi, Reza; Dehghani Nazhvani, Ali; Vahedi, Amir; Gholami, Mehdi; Zare, Raziyeh; Etemadi Parsa, Raha

    2014-01-01

    Statement of the Problem: Alveolar bone necrosis induced by Herpes zoster infection is considered as a rare manifestation of osteomyelitis and few case reports are presented in the literature. Purpose: The aim of this study was to evaluate mandibular osteomyelitis caused by herpes zoster in the immunocompromised patients with histopathologically documented osteomyelitis in the mandible and herpes zoster infection. Materials and Method: 30 patients were recruited in this cross-sectional study. 19 patients were completely edentulous, 4 patients were partially edentulous and 7 with complete dentition. In all cases, specimens were analyzed using a conventional polymerase chain reaction (PCR) test for varicella zoster virus.  Results: 16 patients underwent dialysis, 9 patients received chemotherapy treatments and 5 patients had transplantation (four kidneys and one liver). Histopathological assessment demonstrated a nonspecific bone necrosis exhibiting an eosinophilic, homogeneous non-vital bone tissue with peripheral resorption surrounded by reactive connective tissue. PCR test was positive in 21 cases. Conclusion: This study demonstrated that the frequency of osteomyelitis induced by herpes zoster could be more than the records provided by previous studies. Histopathological findings might be nonspecific in such patients. PCR test was not positive for all HZ induced osteomyelitis patients. PMID:25191659

  8. Cell-mediated immune responses after immunization of healthy seronegative children with varicella vaccine: kinetics and specificity.

    PubMed

    Watson, B; Keller, P M; Ellis, R W; Starr, S E

    1990-10-01

    Humoral and cell-mediated immune responses were determined in seronegative children immunized with live attenuated Oka strain varicella vaccine. At 2 weeks after immunization, 80% of children had detectable lymphocyte proliferation to varicella-zoster virus (VZV) antigens, while only 40% had antibodies to VZV as detected by ELISA. By 6 weeks after immunization, 97% of children seroconverted, and 95% of these responded to VZV antigens in the proliferation assay. A high proportion of immunized children also responded in the proliferation assay to purified glycoproteins I, II, and III of VZV. These results indicate that most children develop a broad cell-mediated immune response to VZV antigens within weeks after immunization with varicella vaccine. PMID:2169495

  9. Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa.

    PubMed

    Schaftenaar, E; Peters, R P H; Baarsma, G S; Meenken, C; Khosa, N S; Getu, S; McIntyre, J A; Osterhaus, A D M E; Verjans, G M G M

    2016-09-01

    The purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with symptoms of infectious keratitis (n = 46) at the ophthalmology outpatient department of three hospitals in rural South Africa. Corneal swabs were tested for herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV) and adenovirus DNA by real-time polymerase chain reaction (PCR) and for bacteria and fungi by culture. Based on clinical history, disease characteristics and laboratory results, 29 (63 %) patients were diagnosed as viral keratitis, including 14 (48 %) viral keratitis cases complicated by bacterial superinfection, and 17 (37 %) as bacterial keratitis. VZV and HSV-1 DNA was detected in 11 (24 %) and 5 (11 %) corneal swabs, respectively. Among clinically defined viral keratitis cases, a negative viral swab was predominantly (93 %) observed in cases with subepithelial inflammation and was significantly associated with an increased duration of symptoms (p = 0.003). The majority of bacteria cultured were Gram-positive (24/35), including Staphylococcus epidermidis and S. aureus. Viral aetiology was significantly associated with a history of herpes zoster ophthalmicus (p < 0.001) and a trend was observed between viral aetiology and HIV infection (p = 0.06). Twenty-one (47 %) keratitis cases were complicated by anterior uveitis, of which 18 (86 %) were HIV-infected cases with viral keratitis. The data implicate a high prevalence of herpetic keratitis, in part complicated by bacterial superinfection and/or uveitis, in HIV-infected individuals presenting with infectious keratitis in rural South Africa. PMID:27236644

  10. Herpes zoster as a cause of viral meningitis in immunocompetent patients.

    PubMed

    Kangath, Raghesh Varot; Lindeman, Tracey Einem; Brust, Karen

    2013-01-01

    A 30-year-old Caucasian woman, without significant medical history or immunosuppression, presented with a 7-day history of severe headache and neck pain. The patient was presumed to have tension headache versus migraine, but was admitted because her symptoms did not resolve. A lumbar puncture was performed showing lymphocytic pleocytosis suggestive of aseptic meningitis and the patient was started on broad-spectrum antibiotics and acyclovir. After admission, a rash was discovered on her left lumbar region with vesicles on top of an erythematous base. Varicella PCR was conducted on the patient's cerebrospinal fluid which was positive. Upon further history, patient was found to have previous varicella infection as a child, but no prior episodes of dermatomal zoster. Therefore, this patient was found to have aseptic meningitis and cutaneous manifestation of disseminated varicella-zoster despite immunocompetence. Antibacterial treatment was discontinued and she was continued on acyclovir for 7 days with transition to valacyclovir for 2 additional weeks with good treatment response and symptom resolution. PMID:23307457

  11. Time Trends in Pediatric Hospitalizations for Varicella Infection Are Associated with Climatic Changes: A 22-Year Retrospective Study in a Tertiary Greek Referral Center

    PubMed Central

    Critselis, Elena; Nastos, Panagiotis T.; Theodoridou, Kalliopi; Theodoridou, Maria; Tsolia, Maria N.; Hadjichristodoulou, Christos; Papaevangelou, Vassiliki

    2012-01-01

    Background/Aims The transmission rate of air-borne infectious diseases may vary secondary to climate conditions. The study assessed time trends in the seasonality of hospitalized varicella cases in a temperate region in relation to climatic parameters prior to the implementation of universal varicella immunization. Methods A retrospective descriptive study was conducted among all pediatric and adolescent varicella patients (n = 2366) hospitalized at the “Aghia Sophia” Children's Hospital during 1982–2003 in Athens, Greece. Date of infection was computed based on hospital admission date. Seasonal and monthly trends in the epidemiology of varicella infection were assessed with time series analysis (ARIMA modeling procedure). The correlation between the frequency of varicella patients and the meteorological parameters was examined by the application of Generalized Linear Models with Gamma distribution. Results During 1982–2003, the occurrence of hospitalized varicella cases increased during summer (p = 0.025) and decreased during autumn (p = 0.021), and particularly in September (p = 0.003). The frequency of hospitalized varicella cases was inversely associated with air temperature (p<0.001). In contrast, the occurrence of hospitalized varicella cases was positively associated with wind speed (p = 0.009). Conclusions Pediatric hospitalizations for varicella infection rates have increased during summer and decreased during autumn in the examined temperate region. Time trends in hospitalized varicella cases are associated with climatic variables. PMID:23284855

  12. [Herpes zoster and postherpetic neuralgia].

    PubMed

    Wollina, U; Machetanz, J

    2016-08-01

    Herpes zoster develops by endogenous reactivation of varizella zoster virus (VZV). Incidence increases with age. Females are more frequently affected than males. The reactivation rate in seropositive individuals is about 20 %. After a short prodromal stage, herpetiform-grouped vesicles appear in segmental arrangement. Pain and paresthesia are typical zoster symptoms. Complications like bacterial superinfections, vasculopathy, paresis, and oculopathy may occur. During pregnancy herpes zoster is a threat for mother and child. Among elderly patients, cardiovascular risk is increased during the first week of herpes zoster infection. Postherpetic neuropathy is feared. Diagnosis can be made clinically and by the use of polymerase chain reaction. First-line treatment is systemic antiviral drug therapy with either acyclovir or brivudine. Adjuvant therapies consist of pain management and topical treatment. PMID:27389412

  13. Clinical and molecular aspects of the live attenuated Oka varicella vaccine.

    PubMed

    Quinlivan, Mark; Breuer, Judy

    2014-07-01

    VZV is a ubiquitous member of the Herpesviridae family that causes varicella (chicken pox) and herpes zoster (shingles). Both manifestations can cause great morbidity and mortality and are therefore of significant economic burden. The introduction of varicella vaccination as part of childhood immunization programs has resulted in a remarkable decline in varicella incidence, and associated hospitalizations and deaths, particularly in the USA. The vaccine preparation, vOka, is a live attenuated virus produced by serial passage of a wild-type clinical isolate termed pOka in human and guinea pig cell lines. Although vOka is clinically attenuated, it can cause mild varicella, establish latency, and reactivate to cause herpes zoster. Sequence analysis has shown that vOka differs from pOka by at least 42 loci; however, not all genomes possess the novel vOka change at all positions, creating a heterogeneous population of genetically distinct haplotypes. This, together with the extreme cell-associated nature of VZV replication in cell culture and the lack of an animal model, in which the complete VZV life cycle can be replicated, has limited studies into the molecular basis for vOka attenuation. Comparative studies of vOka with pOka replication in T cells, dorsal root ganglia, and skin indicate that attenuation likely involves multiple mutations within ORF 62 and several other genes. This article presents an overview of the clinical aspects of the vaccine and current progress on understanding the molecular mechanisms that account for the clinical phenotype of reduced virulence. PMID:24687808

  14. Cutaneous reinnervation of the rectus abdominis musculocutaneous flap after chest wall reconstruction: development of herpes zoster in the transplanted musculocutaneous flap.

    PubMed

    Tomita, K; Inoue, K

    1998-08-01

    We report a patient in whom herpes zoster developed in the transplanted rectus abdominis musculocutaneous flap 14 months after a chest wall reconstruction for recurrent breast cancer. Based on the distribution of the varicella zoster virus spreading along the sensory nerve fibers, we concluded that the virus spread along the reinnervated sensory nerves from the dorsal ganglia, through the intercostal nerves, and into the flap skin. It is suggested that this finding demonstrates the pathway of reinnervation into the transferred musculocutaneous flap on the chest wall. PMID:9718154

  15. Herpes Zoster and Postherpetic Neuralgia: Practical Consideration for Prevention and Treatment

    PubMed Central

    2015-01-01

    Herpes zoster (HZ) is a transient disease caused by the reactivation of latent varicella zoster virus (VZV) in spinal or cranial sensory ganglia. It is characterized by a painful rash in the affected dermatome. Postherpetic neuralgia (PHN) is the most troublesome side effect associated with HZ. However, PHN is often resistant to current analgesic treatments such as antidepressants, anticonvulsants, opioids, and topical agents including lidocaine patches and capsaicin cream and can persist for several years. The risk factors for reactivation of HZ include advanced age and compromised cell-mediated immunity (CMI). Early diagnosis and treatment with antiviral agents plus intervention treatments is believed to shorten the duration and severity of acute HZ and reduce the risk of PHN. Prophylactic vaccination against VZV can be the best option to prevent or reduce the incidence of HZ and PHN. This review focuses on the pathophysiology, clinical features, and management of HZ and PHN, as well as the efficacy of the HZ vaccine. PMID:26175877

  16. A Supraglottic Pseudotumor in an Immunocompromised Patient with Nephrotic Syndrome, Herpes Zoster, and a Cytomegalovirus Infection

    PubMed Central

    Akimoto, Tetsu; Yamazaki, Tomoyuki; Saito, Osamu; Muto, Shigeaki; Kusano, Eiji; Nagata, Daisuke

    2016-01-01

    Several viral infections may occasionally induce supraglottic mass lesions, resulting in an obstructive airway emergency. We herein report one such case in a 63-year-old male immunocompromised patient with nephrotic syndrome due to membranous nephropathy who also had ophthalmic herpes zoster with a laryngeal mass, which required urgent intubation and mechanical ventilation. The patient was initially treated with acyclovir; however, because a serological analysis revealed a concurrent cytomegalovirus infection, we discontinued the administration of acyclovir and gave priority to the simultaneous treatment of the cytomegalovirus and varicella-zoster virus infections with ganciclovir. The clinical course was favorable, and he was weaned from the ventilator 10 days later when a serial imaging analysis revealed no signs of the supraglottic mass, leading us to conclude that these two viral infections could have additively or synergistically contributed to the development of the local pseudotumor. The diagnostic and therapeutic concerns arising in the current case are also discussed. PMID:27547043

  17. Statistical Analysis of Pure Tone Audiometry and Caloric Test in Herpes Zoster Oticus

    PubMed Central

    Kim, Jin; Jung, Jinsei; Moon, In Seok; Lee, Ho-Ki

    2008-01-01

    Objectives Pure tone audiometry and caloric test in patients with herpes zoster oticus were performed to determine the biologic features of the varicella zoster virus (VZV) and the pathogenesis of vestibulocochlear nerve disease in herpes zoster oticus. Study Design A retrospective chart review of 160 patients with herpes zoster oticus was designed in order to determine the classic characteristics of vestibulocochlear nerve disease associated with the syndrome. Speech frequency and isolated high frequency acoustic thresholds were analyzed based on severity of facial paralysis and patient age. Patients without cochlear symptoms were selected randomly, and audiological function was evaluated. Patients with symptoms of vestibular dysfunction underwent the caloric test, and canal paresis was analyzed according to the severity of facial paralysis and the age of each patient. Results Among the 160 patients, 111 exhibited pure tone audiometry; 26 (79%) of the patients with cochlear symptoms and 44 (56%) of the patients without cochlear symptoms had abnormal audiological data. Among the patients without cochlear symptoms, 15 (19%) had hearing loss at speech frequency, and 42 (54%) had hearing loss isolated to high frequency. The incidence of cochlear symptoms in herpes zoster oticus was not related to the severity of facial paralysis. The incidence of patients with isolated high frequency hearing loss statistically increased with age, however the incidence of patients with speech frequency hearing loss did not increase. Thirteen patients complained vertigo, and the incidence of vestibular disturbances and the value of canal paresis in the caloric test increased to statistical significance in parallel with increasing severity of facial paralysis. Conclusion Mild or moderate cochlear symptoms with high frequency hearing loss were related to age, and severe vestibular symptoms were related to the severity of facial paralysis after onset of herpetic symptoms. This study might

  18. Possible enhancement of BP180 autoantibody production by herpes zoster.

    PubMed

    Kamiya, Koji; Aoyama, Yumi; Suzuki, Takahiro; Niwa, Haruo; Horio, Ai; Nishio, Eiichi; Tokura, Yoshiki

    2016-02-01

    Bullous pemphigoid (BP) is an autoimmune blistering disease caused by autoantibodies against type XVII collagen/BP180 (BP180). Although the mechanisms of autoantibody production remain to be elucidated, herpes virus infections have been identified as a possible triggering factor for pemphigus. We report a case of herpes zoster (HZ) having anti-BP180 serum antibodies. The patient developed sudden-onset, tense blisters and edematous erythema on the right anterior chest, shoulder and upper back. Histopathology showed remarkable degeneration of keratinocytes, acantholysis and blister formation with ballooning cells, indicating herpes virus infection. A polymerase chain reaction analysis of varicella zoster virus (VZV) was positive in crusts and effusions from the skin lesions, confirming the definitive diagnosis of HZ. Notably, we found that the patient had anti-BP180 serum antibodies in association with the occurrence of HZ. After successful treatment with valacyclovir hydrochloride for 7 days, the serum levels of anti-BP180 antibodies decreased in accordance with the improvement of skin lesions. These findings suggest that the production of anti-BP180 antibodies could be triggered by the reactivation of VZV. PMID:26212492

  19. Herpes zoster infection increases the risk of peripheral arterial disease

    PubMed Central

    Lin, Te-Yu; Yang, Fu-Chi; Lin, Cheng-Li; Kao, Chia-Hung; Lo, Hsin-Yi; Yang, Tse-Yen

    2016-01-01

    Abstract Varicella-zoster virus infection can cause meningoencephalitis, myelitis, ocular disorders, and vasculopathy. However, no study has investigated the association between herpes zoster (HZ) and peripheral arterial disease (PAD). We identified newly diagnosed HZ from the Taiwan's National Health Insurance Research Database recorded during 2000 to 2010, with a follow-up period extending until December 31, 2011. In addition, we included a comparison cohort that was randomly frequency-matched with the HZ cohort according to age, sex, and index year. We analyzed the risk of PAD with respect to sex, age, and comorbidities by using Cox proportional-hazards regression models. In total, 35,391 HZ patients and 141,556 controls were enrolled in this study. The risk of PAD was 13% increased in the HZ cohort than in the comparison cohort after adjustment for age, sex, and comorbidities. The Kaplan–Meier survival curve showed that the risk of PAD was significantly higher in the HZ cohort than in the non-HZ cohort (P < 0.001). This nationwide population-based cohort study revealed a higher risk of PAD in patients with HZ infection than in those without the infection. Careful follow-up and aggressive treatment is recommended for patients with HZ to reduce the risk of PAD. PMID:27583856

  20. Zoster duplex: a clinical report and etiologic analysis

    PubMed Central

    Zhang, Feng; Zhou, Jin

    2015-01-01

    Objective: Herpes zoster (HZ) duplex is a rare disease presentation. The mechanisms of varicella zoster virus (VZV) reactivation in multiple dermal regions are unknown. To present a HZ duplex case occurring in an immunocompetent woman and to analyze the possible underlying causes of HZ duplex. Methods: We present a HZ duplex case in an immunocompetent woman and analyzed the possible contributing factors in 36 HZ duplex cases. Continuously distributed variables were categorized by numbers and percentages. Results: In our study, 24 cases (66.7%) were from Asia, 16 cases (44.4%) were in individuals ≥ 50 years of age, and 17 cases (47.2%) occurred in immunocompromised patients. Of the 36 cases, 23 involved women (63.9%) and 13 involved men. Eighteen patients suffering from HZ duplex, 13 of which were women (72.2%), did not suffer from any chronic systemic disease or have a long history of taking drugs. Conclusion: HZ duplex is a rare event that can occur in both immunocompetent and immunosuppressed individuals. HZ duplex might be associated with the Asia region, advanced age, immunosuppression, and being female. PMID:26379899

  1. Simian Varicella Virus Is Present in Macrophages, Dendritic Cells, and T Cells in Lymph Nodes of Rhesus Macaques after Experimental Reactivation

    PubMed Central

    Traina-Dorge, Vicki; Doyle-Meyers, Lara A.; Sanford, Robert; Manfredo, Jennifer; Blackmon, Anna; Wellish, Mary; James, Stephanie; Alvarez, Xavier; Midkiff, Cecily; Palmer, Brent E.; Deharo, Eileen; Gilden, Don

    2015-01-01

    ABSTRACT Like varicella-zoster virus (VZV), simian varicella virus (SVV) reactivates to produce zoster. In the present study, 5 rhesus macaques were inoculated intrabronchially with SVV, and 5 months later, 4 monkeys were immunosuppressed; 1 monkey was not immunosuppressed but was subjected to the stress of transportation. In 4 monkeys, a zoster rash developed 7 to 12 weeks after immunosuppression, and a rash also developed in the monkey that was not immunosuppressed. Analysis at 24 to 48 h after zoster revealed SVV antigen in the lung alveolar wall, in ganglionic neurons and nonneuronal cells, and in skin and in lymph nodes. In skin, SVV was found primarily in sweat glands. In lymph nodes, the SVV antigen colocalized mostly with macrophages, dendritic cells, and, to a lesser extent, T cells. The presence of SVV in lymph nodes, as verified by quantitative PCR detection of SVV DNA, might reflect the sequestration of virus by macrophages and dendritic cells in lymph nodes or the presentation of viral antigens to T cells to initiate an immune response against SVV, or both. IMPORTANCE VZV causes varicella (chickenpox), becomes latent in ganglia, and reactivates to produce zoster and multiple other serious neurological disorders. SVV in nonhuman primates has proved to be a useful model in which the pathogenesis of the virus parallels the pathogenesis of VZV in humans. Here, we show that SVV antigens are present in sweat glands in skin and in macrophages and dendritic cells in lymph nodes after SVV reactivation in monkeys, raising the possibility that macrophages and dendritic cells in lymph nodes serve as antigen-presenting cells to activate T cell responses against SVV after reactivation. PMID:26178993

  2. Prenatal sonographic diagnosis of congenital varicella syndrome.

    PubMed

    Tongsong, Theera; Srisupundit, Kasemsri; Traisrisilp, Kuntharee

    2012-01-01

    Congenital varicella syndrome is a rare disorder occurring in less than 1% of maternal varicella during early pregnancy but is associated with high fetal morbidity and mortality. This case report aimed to describe the sonographic features of congenital varicella syndrome following maternal varicella. Well-documented maternal chicken pox was made at 12 weeks of gestation and prenatal ultrasound was performed at 16 weeks. Striking sonographic features included hydropic changes and disseminated calcifications in multiple organs, especially liver and myocardium. Elective termination of pregnancy was done at 17 weeks. The presence of disseminated calcifications could suggest the diagnosis of congenital varicella syndrome. PMID:22323269

  3. Failure of a Single Varicella Vaccination to Protect Children With Cancer From Life-Threatening Breakthrough Varicella

    PubMed Central

    Kelley, James; Tristram, Debra; Yamada, Masaki

    2015-01-01

    We report 2 children with life-threatening breakthrough varicella. Both had received 1 varicella vaccination before onset of cancer. Despite treatment with intravenous acyclovir, 1 child died of disseminated varicella. Because similar fatal cases have been reported, high-risk immunocompromised children with 1 varicella vaccination may warrant the same varicella prophylaxis as immunocompromised children who have never been vaccinated. PMID:25955833

  4. Failure of a Single Varicella Vaccination to Protect Children With Cancer From Life-Threatening Breakthrough Varicella.

    PubMed

    Kelley, James; Tristram, Debra; Yamada, Masaki; Grose, Charles

    2015-09-01

    We report 2 children with life-threatening breakthrough varicella. Both had received 1 varicella vaccination before onset of cancer. Despite treatment with intravenous acyclovir, 1 child died of disseminated varicella. Because similar fatal cases have been reported, high-risk immunocompromised children with 1 varicella vaccination may warrant the same varicella prophylaxis as immunocompromised children who have never been vaccinated. PMID:25955833

  5. Active learning to understand infectious disease models and improve policy making.

    PubMed

    Willem, Lander; Stijven, Sean; Vladislavleva, Ekaterina; Broeckhove, Jan; Beutels, Philippe; Hens, Niel

    2014-04-01

    Modeling plays a major role in policy making, especially for infectious disease interventions but such models can be complex and computationally intensive. A more systematic exploration is needed to gain a thorough systems understanding. We present an active learning approach based on machine learning techniques as iterative surrogate modeling and model-guided experimentation to systematically analyze both common and edge manifestations of complex model runs. Symbolic regression is used for nonlinear response surface modeling with automatic feature selection. First, we illustrate our approach using an individual-based model for influenza vaccination. After optimizing the parameter space, we observe an inverse relationship between vaccination coverage and cumulative attack rate reinforced by herd immunity. Second, we demonstrate the use of surrogate modeling techniques on input-response data from a deterministic dynamic model, which was designed to explore the cost-effectiveness of varicella-zoster virus vaccination. We use symbolic regression to handle high dimensionality and correlated inputs and to identify the most influential variables. Provided insight is used to focus research, reduce dimensionality and decrease decision uncertainty. We conclude that active learning is needed to fully understand complex systems behavior. Surrogate models can be readily explored at no computational expense, and can also be used as emulator to improve rapid policy making in various settings. PMID:24743387

  6. Varicella Viruses Inhibit Interferon-Stimulated JAK-STAT Signaling through Multiple Mechanisms

    PubMed Central

    Verweij, Marieke C.; Wellish, Mary; Whitmer, Travis; Malouli, Daniel; Lapel, Martin; Jonjić, Stipan; Haas, Juergen G.; DeFilippis, Victor R.; Mahalingam, Ravi; Früh, Klaus

    2015-01-01

    Varicella zoster virus (VZV) causes chickenpox in humans and, subsequently, establishes latency in the sensory ganglia from where it reactivates to cause herpes zoster. Infection of rhesus macaques with simian varicella virus (SVV) recapitulates VZV pathogenesis in humans thus representing a suitable animal model for VZV infection. While the type I interferon (IFN) response has been shown to affect VZV replication, the virus employs counter mechanisms to prevent the induction of anti-viral IFN stimulated genes (ISG). Here, we demonstrate that SVV inhibits type I IFN-activated signal transduction via the JAK-STAT pathway. SVV-infected rhesus fibroblasts were refractory to IFN stimulation displaying reduced protein levels of IRF9 and lacking STAT2 phosphorylation. Since previous work implicated involvement of the VZV immediate early gene product ORF63 in preventing ISG-induction we studied the role of SVV ORF63 in generating resistance to IFN treatment. Interestingly, SVV ORF63 did not affect STAT2 phosphorylation but caused IRF9 degradation in a proteasome-dependent manner, suggesting that SVV employs multiple mechanisms to counteract the effect of IFN. Control of SVV ORF63 protein levels via fusion to a dihydrofolate reductase (DHFR)-degradation domain additionally confirmed its requirement for viral replication. Our results also show a prominent reduction of IRF9 and inhibition of STAT2 phosphorylation in VZV-infected cells. In addition, cells expressing VZV ORF63 blocked IFN-stimulation and displayed reduced levels of the IRF9 protein. Taken together, our data suggest that varicella ORF63 prevents ISG-induction both directly via IRF9 degradation and indirectly via transcriptional control of viral proteins that interfere with STAT2 phosphorylation. SVV and VZV thus encode multiple viral gene products that tightly control IFN-induced anti-viral responses. PMID:25973608

  7. Application of Oral Fluid Assays in Support of Mumps, Rubella and Varicella Control Programs

    PubMed Central

    Maple, Peter A. C.

    2015-01-01

    Detection of specific viral antibody or nucleic acid produced by infection or immunization, using oral fluid samples, offers increased potential for wider population uptake compared to blood sampling. This methodology is well established for the control of HIV and measles infections, but can also be applied to the control of other vaccine preventable infections, and this review describes the application of oral fluid assays in support of mumps, rubella and varicella national immunization programs. In England and Wales individuals with suspected mumps or rubella, based on clinical presentation, can have an oral fluid swab sample taken for case confirmation. Universal varicella immunization of children has led to a drastic reduction of chickenpox in those countries where it is used; however, in England and Wales such a policy has not been instigated. Consequently, in England and Wales most children have had chickenpox by age 10 years; however, small, but significant, numbers of adults remain susceptible. Targeted varicella zoster virus (VZV) immunization of susceptible adolescents offers the potential to reduce the pool of susceptible adults and oral fluid determination of VZV immunity in adolescents is a potential means of identifying susceptible individuals in need of VZV vaccination. The main application of oral fluid testing is in those circumstances where blood sampling is deemed not necessary, or is undesirable, and when the documented sensitivity and specificity of the oral fluid assay methodology to be used is considered sufficient for the purpose intended. PMID:26690230

  8. Application of Oral Fluid Assays in Support of Mumps, Rubella and Varicella Control Programs.

    PubMed

    Maple, Peter A C

    2015-01-01

    Detection of specific viral antibody or nucleic acid produced by infection or immunization, using oral fluid samples, offers increased potential for wider population uptake compared to blood sampling. This methodology is well established for the control of HIV and measles infections, but can also be applied to the control of other vaccine preventable infections, and this review describes the application of oral fluid assays in support of mumps, rubella and varicella national immunization programs. In England and Wales individuals with suspected mumps or rubella, based on clinical presentation, can have an oral fluid swab sample taken for case confirmation. Universal varicella immunization of children has led to a drastic reduction of chickenpox in those countries where it is used; however, in England and Wales such a policy has not been instigated. Consequently, in England and Wales most children have had chickenpox by age 10 years; however, small, but significant, numbers of adults remain susceptible. Targeted varicella zoster virus (VZV) immunization of susceptible adolescents offers the potential to reduce the pool of susceptible adults and oral fluid determination of VZV immunity in adolescents is a potential means of identifying susceptible individuals in need of VZV vaccination. The main application of oral fluid testing is in those circumstances where blood sampling is deemed not necessary, or is undesirable, and when the documented sensitivity and specificity of the oral fluid assay methodology to be used is considered sufficient for the purpose intended. PMID:26690230

  9. High Incidence of Herpes Zoster in Nonmyeloablative Hematopoietic Stem Cell Transplantation

    PubMed Central

    Su, Shih Hann; Martel-Laferrière, Valérie; Labbé, Annie-Claude; Snydman, David R.; Kent, David; Laverdière, Michel; Béliveau, Claire; Logvinenko, Tanya; Cohen, Sandra; Lachance, Silvy; Kiss, Thomas; Roy, Jean

    2016-01-01

    Background Nonmyeloablative (NMA) stem cell transplant (HSCT) regimens have expanded in the past decade, but little data exists to support antiviral prophylaxis to prevent zoster in recipients seropositive for varicella-zoster virus in this population. The objectives of this study were to describe the clinical features, incidence and risk factors for herpes zoster (HZ) in a homogeneous cohort of NMA allogeneic HSCT recipients. Methods Retrospective cohort study assessing all patients undergoing sibling NMA HSCT at Hôpital Maisonneuve-Rosemont (Montréal, Canada) between 7/2000-12/2008. All patients transplanted received the same conditioning regimen, immunoprophylaxis and graft-versus-host therapy. Herpes zoster diagnosis was defined clinically. Factors associated with HZ occurrence were identified using a Cox proportional hazards model. Results A total of 179 patients were followed for 33 months (median, IQR: 21-59). Zoster developed in 66 patients (37%) at a median of 8.3 months post-HSCT; the incidence rate was 175 cases/1,000 person-years. Estimated cumulative HZ incidence was 27, 36, and 44% at 1, 2, and 3 years respectively. Thoracic dermatomes were most frequently involved (30%); dissemination occurred in 5 patients. No death resulted from HZ, but 23% developed post-herpetic neuralgia. In multivariate analysis, CMV and HSV reactivations were associated with a reduced likelihood of HZ (hazard ratios=0.54 and 0.33, respectively). Conclusion The incidence of HZ in our cohort of NMA allogeneic transplant recipients is similar to the incidence reported following myeloablative regimens. Antiviral prophylaxis or treatment for CMV and HSV reactivations were protective against HZ. Given the observed high risk, we conclude that recommendations for antiviral prophylaxis should also apply, at least for the first year, to the NMA HSCT population. PMID:20977944

  10. Infectious Complications With the Use of Biologic Response Modifiers in Infants and Children.

    PubMed

    Davies, H Dele

    2016-08-01

    Biologic response modifiers (BRMs) are substances that interact with and modify the host immune system. BRMs that dampen the immune system are used to treat conditions such as juvenile idiopathic arthritis, psoriatic arthritis, or inflammatory bowel disease and often in combination with other immunosuppressive agents, such as methotrexate and corticosteroids. Cytokines that are targeted include tumor necrosis factor α; interleukins (ILs) 6, 12, and 23; and the receptors for IL-1α (IL-1A) and IL-1β (IL-1B) as well as other molecules. Although the risk varies with the class of BRM, patients receiving immune-dampening BRMs generally are at increased risk of infection or reactivation with mycobacterial infections (Mycobacterium tuberculosis and nontuberculous mycobacteria), some viral (herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, hepatitis B) and fungal (histoplasmosis, coccidioidomycosis) infections, as well as other opportunistic infections. The use of BRMs warrants careful determination of infectious risk on the basis of history (including exposure, residence, and travel and immunization history) and selected baseline screening test results. Routine immunizations should be given at least 2 weeks (inactivated or subunit vaccines) or 4 weeks (live vaccines) before initiation of BRMs whenever feasible, and inactivated influenza vaccine should be given annually. Inactivated and subunit vaccines should be given when needed while taking BRMs, but live vaccines should be avoided unless under special circumstances in consultation with an infectious diseases specialist. If the patient develops a febrile or serious respiratory illness during BRM therapy, consideration should be given to stopping the BRM while actively searching for and treating possible infectious causes. PMID:27432853

  11. Epidemiology of Varicella During the 2-Dose Varicella Vaccination Program - United States, 2005-2014.

    PubMed

    Lopez, Adriana S; Zhang, John; Marin, Mona

    2016-01-01

    Before availability of varicella vaccine in the United States, an estimated 4 million varicella cases, 11,000-13,500 varicella-related hospitalizations, and 100-150 varicella-related deaths occurred annually. The varicella vaccination program was implemented in the United States in 1996 as a 1-dose routine childhood program. Based on data from two varicella active surveillance sites, the varicella vaccination program led to 90% decline in incidence over the next decade (1). However, because of continued varicella outbreaks, a routine 2-dose schedule (at ages 12-15 months and 4-6 years) was recommended and has been in place since 2006 (2). The declines in incidence (1,3-6) made it feasible for states to implement varicella case-based surveillance and to report varicella data to CDC through the National Notifiable Diseases Surveillance System (NNDSS). State data have become the primary source for monitoring trends in varicella incidence nationally (7). Using NNDSS data, CDC previously reported nationwide declines in varicella incidence of 72% from the end of the 1-dose to the early years of the 2-dose varicella vaccination program (2006-2010) (7). This report updates varicella incidence trends to include the most recent years in the 2-dose varicella vaccination program. Between the period 2005-2006 (before the 2-dose recommendation) and 2013-2014, overall varicella incidence declined 84.6%, with the largest declines reported in children aged 5-9 years (89.3%) and 10-14 years (84.8%). The availability of varicella-specific data varied over time. During the last 2 years examined (2013 and 2014), completeness of reporting of two critical variables monitored by CDC, vaccination status (receipt of at least 1 dose of varicella vaccine) of cases and severity of disease based on number of lesions, were 54.2% and 39.1%, respectively. State and local health departments, in collaboration with CDC, should continue working to improve reporting of cases and completeness of

  12. Varicella immunogenicity with 1- and 2-dose regimens of measles-mumps-rubella-varicella vaccine.

    PubMed

    Shinefield, Henry R; Black, Steve; Kuter, Barbara J

    2008-03-01

    A quadrivalent vaccine combining measles, mumps, rubella, and varicella antigens (MMRV) was developed to increase the coverage of varicella vaccine and reduce the number of injections children receive. Although the varicella antigen is as immunogenic in the latest formulation of MMRV vaccine as when it is administered alone, up to 14% of vaccine recipients do not achieve protective levels of anti-varicella antibodies after a single dose, which can result in breakthrough varicella. A second dose of varicella vaccine raises response rates to 99% and was recently recommended by the Advisory Committee on Immunization Practices. Giving the second dose 3 months after the first (at approximately 15 months of age) would provide more protection against varicella but would necessitate a change in the childhood vaccination schedule, which currently calls for a second dose of MMRV vaccine between the ages of 4 and 6 years. PMID:18419390

  13. Dental complications of herpes zoster: Two case reports and review of literature.

    PubMed

    Gupta, Swati; Sreenivasan, V; Patil, Prashant B

    2015-01-01

    Herpes zoster (HZ) (shingles) results due to reactivation of varicella-zoster virus. Unusual dental complications like osteonecrosis, exfoliation of teeth, periodontitis, and calcified and devitalized pulps, periapical lesions, and resorption of roots as well as developmental anomalies such as irregular short roots and missing teeth may arise secondary to involvement of 2nd or 3rd division of trigeminal nerve by HZ. Such cases pose both a diagnostic as well as a therapeutic challenge. We report two such rare dental complications of HZ-spontaneous tooth exfoliation and osteonecrosis of the maxilla in a 70-year-old female patient; and multiple periapical pathoses affecting right half of the mandibular teeth in a 45-year-old female patient. Both the patients did not have any associated systemic illness. The aim of this paper was to compare the present cases with all the 46 cases of osteonecrosis and 6 cases of multiple periapical pathoses secondary to trigeminal zoster reported in literature till date The article also throws light that the occurrence of such dental complications of HZ is not entirely dependent on the immune status of the host. PMID:26096121

  14. Herpes Zoster Meningitis Presenting With a Cerebrospinal Fluid Leukemoid Reaction in an Adolescent With preB-ALL in Remission.

    PubMed

    Adachi, Kristina; Song, Sophie X; Kao, Roy L; Van Dyne, Elizabeth; Kempert, Pamela; Deville, Jaime G

    2016-08-01

    A 19-year-old girl with a history of precursor B acute lymphoblastic leukemia in remission presented with fever, headache, and a skin rash. Cerebrospinal fluid (CSF) examination reported pleocytosis with blast-like cells concerning for a central nervous system leukemic relapse. After the patient showed significant improvement on intravenous acyclovir, a repeat lumbar puncture revealed normalization of CSF. The abnormal CSF cells were reviewed and ultimately determined to be activated and atypical lymphocytes. The patient recovered uneventfully. Atypical lymphocytes resembling leukemic blasts are an unusual finding in viral meningitis. Varicella zoster virus reactivation should be considered during initial evaluation for central nervous system relapse of leukemia. PMID:27322719

  15. Focal weakness following herpes zoster.

    PubMed Central

    Cockerell, O C; Ormerod, I E

    1993-01-01

    Three patients presented with focal weakness of an arm which followed segmental herpes zoster affecting the same limb. Neurophysiological investigations suggest that the site of the lesion lay at the root, plexus, or peripheral nerve level. This reflects the various ways in which the virus may affect the peripheral nervous system. PMID:8410022

  16. Cost-effectiveness of vaccination against herpes zoster

    PubMed Central

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN. PMID:25424815

  17. Progress in pediatrics in 2013: choices in allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Vottero, Alessandra; Dascola, Carlotta Povesi; Mirra, Virginia; Sperli, Francesco; Bernasconi, Sergio

    2014-01-01

    This review will provide new information related to pathophysiology and management of specific diseases that have been addressed by selected articles published in the Italian Journal of Pediatrics in 2013, focusing on allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses in children. Recommendations for interpretation of skin prick test to foods in atopic eczema, management of allergic conjunctivitis, hypertension and breastfeeding in women treated with antiepileptic drugs and healthy breakfast have been reported. Epidemiological studies have given emphasis to high incidence of autoimmune disorders in patients with Turner syndrome, increasing prevalence of celiac disease, frequency of hypertension in adolescents, incidence and risk factor for retinopathy of prematurity. Advances in prevention include elucidation of the role of probiotics in reducing occurrence of allergies and feeding intolerance, and events of foetal life that influence later onset of diseases. Mechanistic studies suggested a role for vitamin D deficiency in asthma and type 1 diabetes and for reactivation of Varicella-Zoster virus in aseptic meningitis. Regarding diagnosis, a new mean for the diagnosis of hyperbilirubinaemia in newborns, a score for recognition of impaired nutritional status and growth and criteria for early Dyke-Davidoff-Masson Syndrome have been suggested. New therapeutic approaches consist of use of etanercept for reducing insulin dose in type 1 diabetes, probiotics in atopic eczema, and melatonin in viral infections. PMID:25015124

  18. Functional decline and herpes zoster in older people: an interplay of multiple factors.

    PubMed

    2015-12-01

    Herpes zoster is a frequent painful infectious disease whose incidence and severity increase with age. In older people, there is a strong bidirectional link between herpes zoster and functional decline, which refers to a decrement in ability to perform activities of daily living due to ageing and disabilities. However, the exact nature of such link remains poorly established. Based on the opinion from a multidisciplinary group of experts, we here propose a new model to account for the interplay between infection, somatic/psychiatric comorbidity, coping skills, polypharmacy, and age, which may account for the functional decline related to herpes zoster in older patients. This model integrates the risk of decompensation of underlying disease; the risk of pain becoming chronic (e.g. postherpetic neuralgia); the risk of herpes zoster non-pain complications; the detrimental impact of herpes zoster on quality of life, functioning, and mood; the therapeutic difficulties due to multimorbidity, polypharmacy, and ageing; and the role of stressful life events in the infection itself and comorbid depression. This model underlines the importance of early treatment, strengthening coping, and vaccine prevention. PMID:26440662

  19. Red-Mediated Transposition and Final Release of the Mini-F Vector of a Cloned Infectious Herpesvirus Genome

    PubMed Central

    Wussow, Felix; Fickenscher, Helmut; Tischer, B. Karsten

    2009-01-01

    Bacterial artificial chromosomes (BACs) are well-established cloning vehicles for functional genomics and for constructing targeting vectors and infectious viral DNA clones. Red-recombination-based mutagenesis techniques have enabled the manipulation of BACs in Escherichia coli without any remaining operational sequences. Here, we describe that the F-factor-derived vector sequences can be inserted into a novel position and seamlessly removed from the present location of the BAC-cloned DNA via synchronous Red-recombination in E. coli in an en passant mutagenesis-based procedure. Using this technique, the mini-F elements of a cloned infectious varicella zoster virus (VZV) genome were specifically transposed into novel positions distributed over the viral DNA to generate six different BAC variants. In comparison to the other constructs, a BAC variant with mini-F sequences directly inserted into the junction of the genomic termini resulted in highly efficient viral DNA replication-mediated spontaneous vector excision upon virus reconstitution in transfected VZV-permissive eukaryotic cells. Moreover, the derived vector-free recombinant progeny exhibited virtually indistinguishable genome properties and replication kinetics to the wild-type virus. Thus, a sequence-independent, efficient, and easy-to-apply mini-F vector transposition procedure eliminates the last hurdle to perform virtually any kind of imaginable targeted BAC modifications in E. coli. The herpesviral terminal genomic junction was identified as an optimal mini-F vector integration site for the construction of an infectious BAC, which allows the rapid generation of mutant virus without any unwanted secondary genome alterations. The novel mini-F transposition technique can be a valuable tool to optimize, repair or restructure other established BACs as well and may facilitate the development of gene therapy or vaccine vectors. PMID:19997639

  20. One-dose vaccination associated with attenuated disease severity of adolescent and adult varicella cases in Beijing’s Fengtai District

    PubMed Central

    Zhang, Xue; yu, yuncui; Zhang, Jie; P Kwan, Edwin; Huang, Shengtian; Wang, Zhongzhan; Zhang, Jianjun; Peng, Xiaoxia; Yan, Yuxiang; Zhang, Lin; Luo, Yanxia; Han, Shujing; Han, Xu; Liu, Guangxue; Liu, Fen; Zhao, Jianzhong; He, Yan

    2014-01-01

    Background In recent years, the number of varicella cases in adults has significantly increased in Beijing. However, the effect of the vaccination on varicella-related characteristics among adults has not been studied. Methods and Results: Using data from the Infectious Disease Reporting System and the Immunization Information System, we compared the epidemiology and disease severity in breakthrough and unvaccinated varicella cases in adolescents and adults (≥ 15 year-old) from 2008 to 2011 in Beijing’s Fengtai district, China. The results showed that the age (P = 0.003),contact history (90% vs. 73%, P = 0.019) and outbreak cases (10% vs. 1%, P < 0.0001) were significantly differently distributed between the two groups and that both the incidence of moderate-to-severe cases (26% vs. 45%, P = 0.035, OR = 0.446) and varicella-associated fever (49% vs. 66%, P = 0.068, OR = 0.534) were either significantly lower or trended to be lower in the breakthrough group than in the unvaccinated group. Additionally,vaccine effectiveness against moderate-to-severe cases of varicella was 55.4%. Conclusion: Altogether, these results indicate that vaccination against varicella among adolescents and adults affected the epidemiology and attenuated the disease severity of the cases. The Results from this study will provide useful information for the prevention of varicella in adolescents and adults. PMID:25424949

  1. Three-Dimensional Normal Human Neural Progenitor Tissue-Like Assemblies: A Model for Persistent Varicell-Zoster Virus Infection and Platform to Study Viral Infectivity and Oxidative Stress and Damage

    NASA Technical Reports Server (NTRS)

    Goodwin, T. J.; McCarthy, M.; Osterrieder, N.; Cohrs, R. J.; Kaufer, B. B.

    2014-01-01

    The environment of space results in a multitude of challenges to the human physiology that present barriers to extended habitation and exploration. Over 40 years of investigation to define countermeasures to address space flight adaptation has left gaps in our knowledge regarding mitigation strategies partly due to the lack of investigative tools, monitoring strategies, and real time diagnostics to understand the central causative agent(s) responsible for physiologic adaptation and maintaining homeostasis. Spaceflight-adaptation syndrome is the combination of space environmental conditions and the synergistic reaction of the human physiology. Our work addresses the role of oxidative stress and damage (OSaD) as a negative and contributing Risk Factor (RF) in the following areas of combined spaceflight related dysregulation: i) radiation induced cellular damage [1], [2] ii) immune impacts and the inflammatory response [3], [4] and iii) varicella zoster virus (VZV) reactivation [5]. Varicella-zoster (VZV)/Chicken Pox virus is a neurotropic human alphaherpesvirus resulting in varicella upon primary infection, suppressed by the immune system becomes latent in ganglionic neurons, and reactivates under stress events to re-express in zoster and possibly shingles. Our laboratory has developed a complex threedimensional (3D) normal human neural tissue model that emulates several characteristics of the human trigeminal ganglia (TG) and allows the study of combinatorial experimentation which addresses, simultaneously, OSaD associated with Spaceflight adaptation and habitation [6].

  2. A Rare Complication of Herpes Zoster: Segmental Zoster Paresis

    PubMed Central

    Teo, Hooi Khee; Chawla, Mayank; Kaushik, Manish

    2016-01-01

    Herpes zoster is a common presentation in both the community and emergency department; however segmental zoster paresis is a rare complication that can lead to misdiagnosis. We present a case of a 74-year-old Indian gentleman with a background of well controlled diabetes mellitus, hypertension, and ischaemic heart disease who presented with sudden right lower limb weakness. This was preceded by a 5-day history of paraesthesia starting in the right foot and ascending up the right lower limb. On examination, there was a characteristic vesicular rash in the L2/3 region with MRC grading 3/5 in the right hip flexors. The rest of the neurological examination was unremarkable. MRI of the spine did not show any evidence of spinal disease. The patient was initiated on IV acyclovir with improvement of the lower limb weakness to MRC grading 5/5 as the vesicles improved. This is an interesting case as it highlights a rare presentation of zoster: segmental motor paresis that recovered fully with resolution of the rash. It shows the importance of recognizing motor neuropathy as a complication of shingles as it has a very good prognosis with most patients regaining full motor function of the affected limb with treatment. PMID:27313622

  3. A Rare Complication of Herpes Zoster: Segmental Zoster Paresis.

    PubMed

    Teo, Hooi Khee; Chawla, Mayank; Kaushik, Manish

    2016-01-01

    Herpes zoster is a common presentation in both the community and emergency department; however segmental zoster paresis is a rare complication that can lead to misdiagnosis. We present a case of a 74-year-old Indian gentleman with a background of well controlled diabetes mellitus, hypertension, and ischaemic heart disease who presented with sudden right lower limb weakness. This was preceded by a 5-day history of paraesthesia starting in the right foot and ascending up the right lower limb. On examination, there was a characteristic vesicular rash in the L2/3 region with MRC grading 3/5 in the right hip flexors. The rest of the neurological examination was unremarkable. MRI of the spine did not show any evidence of spinal disease. The patient was initiated on IV acyclovir with improvement of the lower limb weakness to MRC grading 5/5 as the vesicles improved. This is an interesting case as it highlights a rare presentation of zoster: segmental motor paresis that recovered fully with resolution of the rash. It shows the importance of recognizing motor neuropathy as a complication of shingles as it has a very good prognosis with most patients regaining full motor function of the affected limb with treatment. PMID:27313622

  4. Notes from the Field: Varicella Outbreak Associated with Riding on a School Bus - Muskegon County, Michigan, 2015.

    PubMed

    Hoch, Douglas E

    2016-01-01

    On December 3, 2015, Public Health-Muskegon County (PHMC) in Michigan was notified by a local kindergarten-grade 2 school that a student aged 8 years (the index patient) had been sent home because of a rash suspected to be varicella (chickenpox); the rash had not been observed the previous day. Investigation by PHMC revealed that the student was one of five siblings in household A, none of whom had a history of having received any immunizations. During the preceding month the index patient's two older siblings (aged 12 years and 25 years) and two younger siblings (twins, aged 4 years) had been excluded from other schools in this rural district because of rashes that also were suspected to be varicella. Investigators also learned that a parent in household A had received a physician diagnosis of herpes zoster (shingles) nearly 7 weeks earlier, on October 20, after having been evaluated for a painful, unilateral trunk rash that had begun 3 days earlier, and for which acyclovir was prescribed. PHMC could not confirm whether any advice regarding prevention of possible transmission of varicella zoster virus to susceptible contacts was provided. The other children in household A had rash onsets on November 3, November 18 (two children), and November 22. The index patient rode a school bus and was the first student on and the last off each day; none of the index patient's four siblings attended the same school or rode on the same school bus as the index patient. Public health investigators subsequently linked three more cases in children to sharing the same school bus as the index patient. PMID:27606936

  5. Lactation associated with herpes zoster pectoralis.

    PubMed

    Bhattacharya, S K; Girgla, H S

    1976-05-01

    The phenomenon of lactation associated with herpes zoster is unexpected. To our knowledge such an association has been reported only once. A case is reported in whom spontaneous lactation occurred in the ipsilateral breast following herpes zoster. It is believed to have resulted from stimulation of the intercostal nerve endings supplying the overlying skin of the breast. PMID:945354

  6. Disseminated vaccine-strain varicella as initial presentation of the acquired immunodeficiency syndrome: a case report and review of the literature.

    PubMed

    Maves, Ryan C; Tripp, Michael S; Dell, Trevor G; Bennett, Jason W; Ahluwalia, Jaspal S; Tamminga, Cindy; Baldwin, James C; Starr, Clarise Rivera; Grinkemeyer, Michael D; Dempsey, Michael P

    2014-01-01

    Varicella-zoster virus (VZV) infections have declined in many industrialized countries due to vaccination with the attenuated Oka strain virus. Rare cases of severe, disseminated vaccine-strain VZV infection have occurred in the immunocompromised, although rarely in HIV-infected persons. We describe a man with previously-undiagnosed human immunodeficiency virus (HIV) infection who received VZV vaccination and subsequently presented to a combat hospital in Afghanistan with disseminated varicella, respiratory failure, and sepsis. The patient recovered with ventilator and hemodynamic support, intravenous acyclovir, and empiric antibiotic therapy. DNA sequencing detected Oka strain virus from patient blood specimens. Although safe in most populations, the VZV vaccine may cause life-threatening disease in immunocompromised patients. Improved detection of HIV infection may be useful in preventing such cases. PMID:24257110

  7. Evaluation of Chosen Cytokine Levels among Patients with Herpes Zoster as Ability to Provide Immune Response

    PubMed Central

    Zajkowska, Agata; Garkowski, Adam; Świerzbińska, Renata; Kułakowska, Alina; Król, Monika Emilia; Ptaszyńska-Sarosiek, Iwona; Nowicka-Ciełuszecka, Anna; Pancewicz, Sławomir; Czupryna, Piotr; Moniuszko, Anna; Zajkowska, Joanna

    2016-01-01

    Aim and Background Herpes zoster is a viral disease caused by the reactivation of varicella–zoster virus (VZV) which remained latent in the cranial nerve or dorsal root ganglia. Cell-mediated immunity is known to decline with age as part of immunosenescence and can lead to the reactivation of VZV. Whereas herpes zoster is usually mild in healthy young persons, older patients are at increased risk for complications. In the present study we investigated the serum cytokine profile (IL-17, IL-23, IL-21, IL-4, IL-12), representing cellular and humoral immunity and assessed the level of VZV IgG antibodies in patients with herpes zoster. Methods We investigated the serum concentrations of IL-17, IL-23, IL-21, IL-4, IL-12 and the level of VZV IgG antibodies in 23 patients with herpes zoster who did not develop superinfection. The control group was represented by 21 individuals in similar age with no inflammatory and infectious diseases. Cytokine and antibodies levels were measured by ELISA method. Statistical analysis was performed using the ROC curve (receiver operating characteristic), t-test, Welch’s t-test, and nonparametric tests with STATISTICA 10 software. Results In patients with herpes zoster, the serum level of IL-17, IL-23, IL-21, IL-4 and IL-12 as well as VZV IgG antibodies titer were statistically significantly increased compared to control group. Conclusion Our results confirm the broad activation of the immune system involving humoral and cell-mediated immunity. PMID:26934574

  8. Treatment of herpes zoster with Clinacanthus nutans (bi phaya yaw) extract.

    PubMed

    Sangkitporn, S; Chaiwat, S; Balachandra, K; Na-Ayudhaya, T D; Bunjob, M; Jayavasu, C

    1995-11-01

    A randomized, placebo-controlled trial of the efficacy of topical formulation of Clinacanthus nutans (Bi Phaya Yaw) extract was carried out in 51 patients with varicella-zoster virus infection. The study medication was applied five times daily for 7-14 days until the lesions were healed. The number of patients with lesion crusting within 3 days and with lesion healing within 7 days and 10 days were significantly greater in the C. nutans extract-treated group than the placebo group (p < 0.01). Pain scores were reduced more rapidly in the C. nutans extract-treated group than in the placebo group. There were no side effects of the study medication. PMID:8576675

  9. A deterministic model for highly contagious diseases: The case of varicella

    NASA Astrophysics Data System (ADS)

    Acedo, L.; Moraño, J.-A.; Santonja, F.-J.; Villanueva, R.-J.

    2016-05-01

    The classic nonlinear Kermack-McKendrick model based upon a system of differential equations has been widely applied to model the rise and fall of global pandemic and also seasonal epidemic by introducing a forced harmonic infectivity which would change throughout the year. These methods work well in their respective domains of applicability, and for certain diseases, but they fail when both seasonality and high infectivity are combined. In this paper we consider a Susceptible-Infected-Recovered, or SIR, model with two latent states to model the propagation and evolutionary history of varicella in humans. We show that infectivity can be calculated from real data and we find a nonstandard seasonal variation that cannot be fitted with a single harmonic. Moreover, we show that infectivity for the present strains of the virus has raised following a sigmoid function in a period of several centuries. This could allow the design of vaccination strategies and the study of the epidemiology of varicella and herpes zoster.

  10. Characterization of the immune response in ganglia after primary simian varicella virus infection.

    PubMed

    Ouwendijk, Werner J D; Getu, Sarah; Mahalingam, Ravi; Gilden, Don; Osterhaus, Albert D M E; Verjans, Georges M G M

    2016-06-01

    Primary simian varicella virus (SVV) infection in non-human primates causes varicella, after which the virus becomes latent in ganglionic neurons and reactivates to cause zoster. The host response in ganglia during establishment of latency is ill-defined. Ganglia from five African green monkeys (AGMs) obtained at 9, 13, and 20 days post-intratracheal SVV inoculation (dpi) were analyzed by ex vivo flow cytometry, immunohistochemistry, and in situ hybridization. Ganglia at 13 and 20 dpi exhibited mild inflammation. Immune infiltrates consisted mostly of CD8(dim) and CD8(bright) memory T cells, some of which expressed granzyme B, and fewer CD11c(+) and CD68(+) cells. Chemoattractant CXCL10 transcripts were expressed in neurons and infiltrating inflammatory cells but did not co-localize with SVV open reading frame 63 (ORF63) RNA expression. Satellite glial cells expressed increased levels of activation markers CD68 and MHC class II at 13 and 20 dpi compared to those at 9 dpi. Overall, local immune responses emerged as viral DNA load in ganglia declined, suggesting that intra-ganglionic immunity contributes to restricting SVV replication. PMID:26676825

  11. A recombinant varicella vaccine harboring a respiratory syncytial virus gene induces humoral immunity.

    PubMed

    Murakami, Kouki; Matsuura, Masaaki; Ota, Megumi; Gomi, Yasuyuki; Yamanishi, Koichi; Mori, Yasuko

    2015-11-01

    The varicella-zoster virus (VZV) Oka vaccine strain (vOka) is highly efficient and causes few adverse events; therefore, it is used worldwide. We previously constructed recombinant vOka (rvOka) harboring the mumps virus gene. Immunizing guinea pigs with rvOka induced the production of neutralizing antibodies against the mumps virus and VZV. Here, we constructed recombinant vOka viruses containing either the respiratory syncytial virus (RSV) subgroup A fusion glycoprotein (RSV A-F) gene or RSV subgroup B fusion glycoprotein (RSV B-F) gene (rvOka-RSV A-F or rvOka-RSV B-F). Indirect immunofluorescence and Western blot analyses confirmed the expression of each recombinant RSV protein in virus-infected cells. Immunizing guinea pigs with rvOka-RSV A-F or rvOka-RSV B-F led to the induction of antibodies against RSV proteins. These results suggest that the current varicella vaccine genome can be used to generate custom-made vaccine vectors to develop the next generation of live vaccines. PMID:26116253

  12. [Measles, mumps, rubella and varicella: antibody titration and vaccinations in a large hospital].

    PubMed

    Cologni, L; Belotti, L; Bacis, M; Moioli, F; Goglio, A; Mosconi, G

    2012-01-01

    The occurrence contagious diseases such as measles, varicella, mumps and rubella in the hospital open creates situations of alarm, due to the potential involvement of workers, but most importantly for the oftentimes harmful consequences for critical patients, such as pregnant women or immunocompromised individuals. In 2007 antibody titration was initiated in our hospital for four infectious diseases, also pursuant to the Lombardy Region Resolution N. VIII/1587 of 22-12-2005 "Decisions regarding vaccinations in children and adults in the Lombardy Region" which indicate the departments in which a priority exists: maternity-neonatal and infectious illnesses. In 2011 a vaccination campaign was launched for unprotected operators in the Health and Medical Management departments: after an interview with the competent physician of reference, the subjects voluntary submitted themselves to vaccination. The protective antibody data encountered over the years are similar to that reported in the literature, with coverage percentages greater than 93% for varicella and rubella, over 89% for measles and over 85% for mumps. Approximately 80% of the operators are protected against all four diseases. However, the dramatic consequences of potential contagion lead us to strongly recommend vaccinations for non-protected subjects. At present 37 operators have been vaccinated with the trivalent MMR vaccine (Measles, Mumps and Rubella) and 14 for Varicella. The antibody response was verified in all cases. PMID:23405639

  13. Case of herpes zoster duplex bilateralis.

    PubMed

    Shin, Bong Seok; Seo, Hyun Deok; Na, Chan Ho; Choi, Kyu Chul

    2009-02-01

    Non-contiguously simultaneous development of herpes zoster is very rare. It is named either herpes zoster duplex unilateralis or bilaterarlis, depending on whether one or both sides of the body are involved. Herein, we report a 21-year-old man, who had been treated for ulcerative colitis with prednisolone, and presented with painful grouped vesicles of the lower abdomen and back in a relatively symmetrical distribution. A Tzanck smear and punch biopsy were performed on the vesicles of the back. We report a rare case of symmetrical herpes zoster duplex bilateralis. PMID:19284453

  14. Herpes zoster virus: an unusual but potentially treatable cause of sciatica and foot drop.

    PubMed

    Sprenger De Rover, Walter B; Alazzawi, Sulaiman; Hallam, Peter J; Hutchinson, Rachael; Di Mascio, Livio

    2011-12-01

    The herpes zoster virus is a rare but potential cause of acute motor weakness. This article describes 2 patients with drop foot secondary to an infection of varicella zoster who were incorrectly referred to an orthopedic clinic from their general practitioners. The first patient was a 74-year-old man who presented with weakness in the right foot and a vesicular rash. The pattern of disease supported the clinical diagnosis of shingles affecting the L5 motor and sensory division. No investigation was required, and the patient was treated with a foot drop splint. The second patient was a 71-year-old man who presented with right leg and foot weakness and a vesicular rash affecting his right buttock and posterior right thigh. Lumbar magnetic resonance excluded a stenotic lesion; electrophysiological studies supported the diagnosis of a lower motor neuron lesion. The patient was treated with a 1-week course of acyclovir and a foot drop splint. The correct diagnosis will aid in correct referral and will prompt management, which will potentially provide a faster and better outcome for the patient. PMID:22146220

  15. Genetic variation in the HLA region is associated with susceptibility to herpes zoster

    PubMed Central

    Crosslin, D R; Carrell, D S; Burt, A; Kim, D S; Underwood, J G; Hanna, D S; Comstock, B A; Baldwin, E; de Andrade, M; Kullo, I J; Tromp, G; Kuivaniemi, H; Borthwick, K M; McCarty, C A; Peissig, P L; Doheny, K F; Pugh, E; Kho, A; Pacheco, J; Hayes, M G; Ritchie, M D; Verma, S S; Armstrong, G; Stallings, S; Denny, J C; Carroll, R J; Crawford, D C; Crane, P K; Mukherjee, S; Bottinger, E; Li, R; Keating, B; Mirel, D B; Carlson, C S; Harley, J B; Larson, E B; Jarvik, G P

    2015-01-01

    Herpes zoster, commonly referred to as shingles, is caused by the varicella zoster virus (VZV). VZV initially manifests as chicken pox, most commonly in childhood, can remain asymptomatically latent in nerve tissues for many years and often re-emerges as shingles. Although reactivation may be related to immune suppression, aging and female sex, most inter-individual variability in re-emergence risk has not been explained to date. We performed a genome-wide association analyses in 22 981 participants (2280 shingles cases) from the electronic Medical Records and Genomics Network. Using Cox survival and logistic regression, we identified a genomic region in the combined and European ancestry groups that has an age of onset effect reaching genome-wide significance (P>1.0 × 10−8). This region tags the non-coding gene HCP5 (HLA Complex P5) in the major histocompatibility complex. This gene is an endogenous retrovirus and likely influences viral activity through regulatory functions. Variants in this genetic region are known to be associated with delay in development of AIDS in people infected by HIV. Our study provides further suggestion that this region may have a critical role in viral suppression and could potentially harbor a clinically actionable variant for the shingles vaccine. PMID:25297839

  16. Genetic variation in the HLA region is associated with susceptibility to herpes zoster.

    PubMed

    Crosslin, D R; Carrell, D S; Burt, A; Kim, D S; Underwood, J G; Hanna, D S; Comstock, B A; Baldwin, E; de Andrade, M; Kullo, I J; Tromp, G; Kuivaniemi, H; Borthwick, K M; McCarty, C A; Peissig, P L; Doheny, K F; Pugh, E; Kho, A; Pacheco, J; Hayes, M G; Ritchie, M D; Verma, S S; Armstrong, G; Stallings, S; Denny, J C; Carroll, R J; Crawford, D C; Crane, P K; Mukherjee, S; Bottinger, E; Li, R; Keating, B; Mirel, D B; Carlson, C S; Harley, J B; Larson, E B; Jarvik, G P

    2015-01-01

    Herpes zoster, commonly referred to as shingles, is caused by the varicella zoster virus (VZV). VZV initially manifests as chicken pox, most commonly in childhood, can remain asymptomatically latent in nerve tissues for many years and often re-emerges as shingles. Although reactivation may be related to immune suppression, aging and female sex, most inter-individual variability in re-emergence risk has not been explained to date. We performed a genome-wide association analyses in 22,981 participants (2280 shingles cases) from the electronic Medical Records and Genomics Network. Using Cox survival and logistic regression, we identified a genomic region in the combined and European ancestry groups that has an age of onset effect reaching genome-wide significance (P>1.0 × 10(-8)). This region tags the non-coding gene HCP5 (HLA Complex P5) in the major histocompatibility complex. This gene is an endogenous retrovirus and likely influences viral activity through regulatory functions. Variants in this genetic region are known to be associated with delay in development of AIDS in people infected by HIV. Our study provides further suggestion that this region may have a critical role in viral suppression and could potentially harbor a clinically actionable variant for the shingles vaccine. PMID:25297839

  17. Herpes zoster infection increases the risk of peripheral arterial disease: A nationwide cohort study.

    PubMed

    Lin, Te-Yu; Yang, Fu-Chi; Lin, Cheng-Li; Kao, Chia-Hung; Lo, Hsin-Yi; Yang, Tse-Yen

    2016-08-01

    Varicella-zoster virus infection can cause meningoencephalitis, myelitis, ocular disorders, and vasculopathy. However, no study has investigated the association between herpes zoster (HZ) and peripheral arterial disease (PAD).We identified newly diagnosed HZ from the Taiwan's National Health Insurance Research Database recorded during 2000 to 2010, with a follow-up period extending until December 31, 2011. In addition, we included a comparison cohort that was randomly frequency-matched with the HZ cohort according to age, sex, and index year. We analyzed the risk of PAD with respect to sex, age, and comorbidities by using Cox proportional-hazards regression models.In total, 35,391 HZ patients and 141,556 controls were enrolled in this study. The risk of PAD was 13% increased in the HZ cohort than in the comparison cohort after adjustment for age, sex, and comorbidities. The Kaplan-Meier survival curve showed that the risk of PAD was significantly higher in the HZ cohort than in the non-HZ cohort (P < 0.001).This nationwide population-based cohort study revealed a higher risk of PAD in patients with HZ infection than in those without the infection. Careful follow-up and aggressive treatment is recommended for patients with HZ to reduce the risk of PAD. PMID:27583856

  18. Frosted branch angiitis caused by Varicella Zoster virus in an immunocompetent patient

    PubMed Central

    Talebi-Taher, Mahshid; Javadzadeh, Ali; Hedayatfar, Alireza; Rahmani, Shahrzad; Ghanooni, Amir Hossein; Mahmoodian, Reihaneh

    2015-01-01

    Introduction: Frosted branch angiitis(FBA) is a panuveitis with sheating of all retinal vesssels. Case presentation: Herein we report an immunocompetent person who presented with fever, headache, atypical rash, and hazy vision. Ophthalmoscopy of both eyes revealed perivascular sheathing with frosted branch angiitis pattern in veins, patchy retinal hemorrhages. Aqueous PCR analysis turned positive for VZV. Discussion: This case illustrates that VZV should be considered in the differential diagnosis of retinal perivasculitis. Since a rapid and accurate diagnosis is crucial for prompt administration of antiviral therapy, PCR-based analysis of aqueous humor is a valuable tool for detecting viruses. PMID:26622973

  19. Varicella-zoster virus induces the formation of dynamic nuclear capsid aggregates

    SciTech Connect

    Lebrun, Marielle; Thelen, Nicolas; Thiry, Marc; Riva, Laura; Ote, Isabelle; Condé, Claude; Vandevenne, Patricia; Di Valentin, Emmanuel; Bontems, Sébastien; Sadzot-Delvaux, Catherine

    2014-04-15

    The first step of herpesviruses virion assembly occurs in the nucleus. However, the exact site where nucleocapsids are assembled, where the genome and the inner tegument are acquired, remains controversial. We created a recombinant VZV expressing ORF23 (homologous to HSV-1 VP26) fused to the eGFP and dually fluorescent viruses with a tegument protein additionally fused to a red tag (ORF9, ORF21 and ORF22 corresponding to HSV-1 UL49, UL37 and UL36). We identified nuclear dense structures containing the major capsid protein, the scaffold protein and maturing protease, as well as ORF21 and ORF22. Correlative microscopy demonstrated that the structures correspond to capsid aggregates and time-lapse video imaging showed that they appear prior to the accumulation of cytoplasmic capsids, presumably undergoing the secondary egress, and are highly dynamic. Our observations suggest that these structures might represent a nuclear area important for capsid assembly and/or maturation before the budding at the inner nuclear membrane. - Highlights: • We created a recombinant VZV expressing the small capsid protein fused to the eGFP. • We identified nuclear dense structures containing capsid and procapsid proteins. • Correlative microscopy showed that the structures correspond to capsid aggregates. • Procapsids and partial capsids are found within the aggregates of WT and eGFP-23 VZV. • FRAP and FLIP experiments demonstrated that they are dynamic structures.

  20. Herpes Zoster and Postherpetic Neuralgia: a review of the effects of vaccination.

    PubMed

    Johnson, Robert W

    2009-06-01

    Herpes zoster (HZ) results from reactivation of varicella zoster virus which has been persistent but clinically latent in dorsal root and cranial nerve ganglia since primary infection, usually as a child, with varicella (chicken pox). HZ affects 20-30% of individuals during their lifetime and up to 50% of those > or =80 years old. Although serious life- or sight-threatening complications occur rarely, postherpetic neuralgia (PHN) is the most common complication. Both HZ and PHN are most common in the elderly. Declining cell-mediated immunity resulting from immune senescence appears to be the cause. Incidence of HZ is also high in individuals who are immunocompromised as a result of disease or its treatment. HZ also occurs in younger and fit individuals but is usually mild and complications are rare. Current management of HZ with antiviral drugs and analgesics attains quite good control of acute pain and skin rash but offers only partial protection against PHN. Other strategies studied to prevent PHN such as nerve blocks are relatively ineffective and clinically impractical. Although several drug classes are used to manage PHN, numbers needed to treat to obtain 50% pain reduction range from approx. 2.5-5 and adverse effects are common. The elderly population is growing and thus the number of HZ and PHN susceptible individuals is increasing. HZ and PHN are expensive in terms of suffering, loss of independence and healthcare costs. Significant numbers of the elderly with HZ require hospitalization. Short-term illness in the elderly can lead to long-term loss of independence. A live attenuated herpes zoster vaccine has been studied in a large number of subjects and shown to reduce incidence of HZ as well as incidence and severity of PHN. The safety profile of the vaccine is good, local soreness at the injection site being the only common adverse event. Health economics studies suggest that vaccination of adults about 60 years of age would be cost effective. Duration of

  1. Risk of varicella infection during late pregnancy.

    PubMed Central

    Koren, Gideon

    2003-01-01

    QUESTION: I have a patient who contracted varicella at 26 weeks' gestation. She is very concerned and would consider termination if it were earlier in the pregnancy. What are the current predictions of risk for her fetus? ANSWER: Based on review of all available studies, we could not detect a single case of congenital varicella syndrome in the third trimester of pregnancy (0/208), as compared with 5/645 (0.78%) in the first and 9/592 (1.52%) in the second trimester (P < .01 third vs first and second). You can reassure your patient. PMID:14649980

  2. Evidence-based interventional pain medicine according to clinical diagnoses. 17. Herpes zoster and post-herpetic neuralgia.

    PubMed

    van Wijck, Albert J M; Wallace, Mark; Mekhail, Nagy; van Kleef, Maarten

    2011-01-01

    Herpes zoster infection is caused by a reactivation of the latent varicella zoster virus that causes chicken pox. It appears predominantly in older adults whose immunity for the virus has waned. The natural course of the disease is usually favorable, and the symptoms disappear spontaneously within a few weeks. Some patients, however, have prolonged pain: post-herpetic neuralgia. The diagnosis of acute zoster infection is made on the clinical signs including the appearance of rash. Post-herpetic neuralgia is described as sharp, burning, aching, or shooting constantly present in the dermatome that corresponds with the earlier rash. The objectives of treating herpes zoster are: (1) acute pain reduction; (2) promotion of recovery of epidermal defects and prevention of secondary infections; and (3) reduction or prevention of post-herpetic neuralgia. The objective of the treatment of post-herpetic neuralgia is primarily pain alleviation and improvement of the quality of life. Early treatment of the infection and the pain is believed to reduce the risk for post-herpetic neuralgia. This persistent pain syndrome is difficult to treat. Antiepileptic drugs and tricyclic antidepressants are the first choice. Interventional treatments, such as epidural injections of corticosteroids and local anesthetic drugs, have an effect on the acute pain but are of limited use in preventing post-herpetic neuralgia. When conservative treatment fails in providing satisfactory relief of post-herpetic neuralgia, a sympathetic block may be considered (2 C+); if this treatment provides unsatisfactory results, spinal cord stimulation may be considered, in a study context (2 C+). PMID:21114617

  3. Infectious Diseases

    MedlinePlus

    Infectious diseases kill more people worldwide than any other single cause. Infectious diseases are caused by germs. Germs are tiny living ... to live NIH: National Institute of Allergy and Infectious Diseases

  4. Infectious Diseases

    MedlinePlus

    Infectious diseases kill more people worldwide than any other single cause. Infectious diseases are caused by germs. Germs are tiny living ... live NIH: National Institute of Allergy and Infectious Diseases

  5. MMRV (measles, mumps, rubella, and varicella) vaccine - what you need to know

    MedlinePlus

    ... taken in its entirety from the CDC MMRV (Measles, Mumps, Rubell and Varicella) Vaccine Information Statement (VIS): ... Measles, Mumps, Rubella & Varicella Measles, Mumps, Rubella, and Varicella (chickenpox) can be serious diseases: Measles Causes rash, ...

  6. MMRV (measles, mumps, rubella, and varicella) vaccine - what you need to know

    MedlinePlus

    ... Mumps, Rubella & Varicella Measles, Mumps, Rubella, and Varicella (chickenpox) can be serious diseases: Measles Causes rash, cough, ... could be born with serious birth defects. Varicella (Chickenpox) Causes rash, itching, fever, tiredness. Can lead to ...

  7. Varicella-Like Cutaneous Toxoplasmosis in a Patient with Aplastic Anemia

    PubMed Central

    Zimmermann, Stefan; Hadaschik, Eva; Dalpke, Alexander; Hassel, Jessica C.; Ajzenberg, Daniel; Tenner-Racz, Klara; Lehners, Nicola; Kapaun, Annette

    2013-01-01

    A 60-year-old patient with aplastic anemia presented with vesicular varicella-like skin lesions on her face, arms, legs, back, and abdomen. However, diagnosis for herpetic infection was negative. Findings of a skin biopsy led to a tentative histologic diagnosis of toxoplasmosis, and infection with Toxoplasma gondii was confirmed by immunohistochemistry and PCR. Cutaneous toxoplasmosis is a rare finding in immunocompromised patients and might mimic other infectious diseases, and vesicular lesions associated with toxoplasmosis have not been reported previously. PMID:23390283

  8. Varicella-like cutaneous toxoplasmosis in a patient with aplastic anemia.

    PubMed

    Zimmermann, Stefan; Hadaschik, Eva; Dalpke, Alexander; Hassel, Jessica C; Ajzenberg, Daniel; Tenner-Racz, Klara; Lehners, Nicola; Kapaun, Annette; Schnitzler, Paul

    2013-04-01

    A 60-year-old patient with aplastic anemia presented with vesicular varicella-like skin lesions on her face, arms, legs, back, and abdomen. However, diagnosis for herpetic infection was negative. Findings of a skin biopsy led to a tentative histologic diagnosis of toxoplasmosis, and infection with Toxoplasma gondii was confirmed by immunohistochemistry and PCR. Cutaneous toxoplasmosis is a rare finding in immunocompromised patients and might mimic other infectious diseases, and vesicular lesions associated with toxoplasmosis have not been reported previously. PMID:23390283

  9. [Results of Booster Vaccination in Children with Primary Vaccine Failure after Initial Varicella Vaccination].

    PubMed

    Ozakiv, Takao; Nishimura, Naoko; Gotoh, Kensei; Funahashi, Keiji; Yoshii, Hironori; Okuno, Yoshinobu

    2016-05-01

    In October 2014, the varicella vaccination policy in Japan was changed from a single voluntary inoculation to two routine inoculations. This paper reports the results of booster vaccination in children who did not show seroconversion after initial vaccination (i.e., primary vaccine failure : PVF) over a 7-year period prior to the introduction of routine varicella vaccination. Between November 2007 and May 2014, 273 healthy children aged between 1.1 and 14.5 years (median : 1.7 years) underwent varicella vaccination. Before and 4 to 6 weeks after vaccination, the antibody titers were measured using an immune adherence hemagglutination (IAHA) assay and a glycoprotein-based enzyme-linked immunosorbent assay (gpELISA). In addition, side reactions were examined during the four-week period after vaccination. Children who did not show IAHA seroconversion (PVF) were recommended to receive a booster vaccination, and the measurement of antibody titers and an assessment of side reactions were performed after the booster dose. In May 2015, a questionnaire was mailed to each of the 273 participants to investigate whether they had developed varicella and/or herpes zoster after vaccination. After initial vaccination, the IAHA seroconversion rate was 75% and the mean antibody titer (Log2) with seroconversion was 4.7, while the gpELISA seroconversion rate was 84% and the mean antibody titer (Log10) with seroconversion was 2.4. Among children with PVF, 54 received booster vaccination within 81 to 714 days (median : 139 days) after the initial vaccination. After booster vaccination, the IAHA seroconversion rate was 98% and the mean antibody titer (Log2) with seroconversion was 5.8. Both the seroconversion rate and the antibody titer were higher compared with the values after the initial vaccination (p < 0.01). After booster vaccination, the gpELISA seropositive rate was 100% and the mean positive antibody titer (Log 10) was 3.6 ; similar results were obtained for the IAHA assay, with

  10. Burden of varicella in Italy, 2001-2010: analysis of data from multiple sources and assessment of universal vaccination impact in three pilot regions.

    PubMed

    Trucchi, Cecilia; Gabutti, Giovanni; Rota, Maria Cristina; Bella, Antonino

    2015-11-01

    Varicella represents the most widespread vaccine-preventable childhood infectious disease in Italy. The purpose of this retrospective study was to assess the burden of varicella in Italy and in three regions that first implemented universal varicella vaccination. Four data sources were analysed: statutory notification data, the National Hospital Discharge Database, mortality data, and the vaccination coverage reached in Sicilia, Veneto and Apulia. The incidence rates per 100,000 population were calculated using the Italian resident population provided by the Italian Institute of Statistics in 2001-2010. In 2001-2010, the mean annual incidence of notifications of varicella was 150.7 cases per 100,000 population, reaching 948.6 cases per 100,000 population in the paediatric age group. The annual incidence declined to 102.6 per 100,000 population in 2010. During the period considered, 20,295 hospitalizations for varicella were observed. The mean annual incidence was 3.4 per 100,000 population, reaching a minimum of 2.5 per 100,000 in 2009 and 2010. Of the hospitalizations, 68.4% occurred in the paediatric age group. The median length of hospital stay was 4 days. During 2001-2003 and 2006-2010, 33 deaths were reported. In the three regions considered, vaccination coverage increased steadily, reaching 81.5% in Sicily, 79.4% in Veneto and 75.6% in Apulia in 2010. During the same period, hospitalization and notification rates decreased significantly. This study demonstrated that varicella continues to represent a relevant health problem in Italy, especially in the paediatric age group. Data obtained from the three Italian regions that first introduced universal vaccination demonstrated that vaccination reduces the incidence of varicella and hospitalization rates. PMID:25813818

  11. Early-second-trimester use of acyclovir in treating herpes zoster in a bone marrow transplant patient. A case report.

    PubMed

    Horowitz, G M; Hankins, G D

    1992-03-01

    Bone marrow transplantation from a human leukocyte antigen (HLA)-identical sibling for treatment of severe aplastic anemia among women of reproductive age is becoming more common. Successful pregnancy has been reported to occur in several such patients. A woman delivered a healthy, term, female infant 18 months after a transplant from her HLA-identical sister. Her pregnancy was complicated by disseminated herpes zoster, treated with intravenous acyclovir at 14 weeks' gestation, before the diagnosis of pregnancy. While there have been several case reports involving the use of acyclovir in the third trimester, primarily in the treatment of varicella infections, there have been no previous reports of such an early utilization of this antiviral drug. PMID:1564715

  12. Herpes Zoster-Induced Ogilvie's Syndrome

    PubMed Central

    Masood, Irfan; Majid, Zain; Rind, Waqas; Zia, Aisha; Riaz, Haris; Raza, Sajjad

    2015-01-01

    Ogilvie's syndrome due to herpes zoster infection is a rare manifestation of VZV reactivation. The onset of rash of herpes zoster and the symptoms of intestinal obstruction can occur at different time intervals posing a significant diagnostic challenge resulting in avoidable surgical interventions. Herein, we describe a case of 35-year-old male who presented with 6-day history of constipation and colicky abdominal pain along with an exquisitely tender and vesicular skin eruption involving the T8–T11 dermatome. Abdominal X-ray and ultrasound revealed generalized gaseous distention of the large intestine with air up to the rectum consistent with paralytic ileus. Colonoscopy did not show any obstructing lesion. A diagnosis of Ogilvie's syndrome associated with herpes zoster was made. He was conservatively managed with nasogastric decompression, IV fluids, and acyclovir. The patient had an uneventful recovery and was later discharged. PMID:26664758

  13. Spinal Arteriovenous Malformation Masquerating Zoster Sine Herpete

    PubMed Central

    Lee, Ji Young; Ok, Se Jin; Oh, Chang Keun; Park, Sun Kyung; Kim, Do Wan

    2013-01-01

    Zoster sine herpete (ZSH) is difficult to diagnosis during an acute period due to the absence of the characteristic zosteriform dermatomal rash; therefore, progression to postherpetic neuralgia is more common than typical zoster. In addition, misdiagnosis of other neuropathic pain as ZSH is common in clinical situations. Here, we report a case of spinal arteriovenous malformation that mimics ZSH. This is a rare condition; therefore, high clinical suspicion for a correct diagnosis and proper examination are not easy. However, early diagnosis and definitive treatment are essential to prevent neurologic deficit and mortality. PMID:23342212

  14. Family Characteristics Associated with Likelihood of Varicella Vaccination

    PubMed Central

    Weinmann, Sheila; Mullooly, John P; Drew, Lois; Chun, Colleen S

    2016-01-01

    Context: The introduction of the varicella vaccine as a routine pediatric immunization in the US, in 1995, provided an opportunity to assess factors associated with uptake of new vaccines in the member population of the Kaiser Permanente Northwest (KPNW) Health Plan. Objective: Identify factors associated with varicella vaccination in the KPNW population in the first five years after varicella vaccine was introduced. Design: A retrospective cohort of children under age 13 years between June 1995 and December 1999, without a history of varicella disease was identified using KPNW automated data. Membership records were linked to vaccine databases. Cox regression was used to estimate likelihood of varicella vaccination during the study period in relation to age, sex, primary clinician’s specialty, and Medicaid eligibility. For a subset whose parents answered a behavioral health survey, additional demographic and behavioral characteristics were evaluated. Main Outcome Measure: Varicella vaccination. Results: We identified 88,646 children under age 13 years without a history of varicella; 22% were vaccinated during the study period. Varicella vaccination was more likely among children who were born after 1995, were not Medicaid recipients, or had pediatricians as primary clinicians. In the survey-linked cohort, positively associated family characteristics included smaller family size; higher socioeconomic status; and parents who were older, were college graduates, reported excellent health, and received influenza vaccination. Conclusion: Understanding predictors of early varicella vaccine-era vaccine acceptance may help in planning for introduction of new vaccines to routine schedules. PMID:27104589

  15. Vaccinating HIV patients: focus on human papillomavirus and herpes zoster vaccines.

    PubMed

    Koenig, Helen C; Garland, Joseph M; Weissman, Drew; Mounzer, Karam

    2013-01-01

    Vaccination has been one of our most powerful tools to decrease morbidity and mortality from infectious diseases in the last century. It is critical to understand the evolving safety and efficacy data for vaccines in HIV-infected individuals as the number of people living with HIV in the United States and globally continues to increase. The quadrivalent human papillomavirus vaccine and the herpes zoster vaccine are newly licensed in the general population, and several studies have recently been published on the safety and efficacy of these vaccines in HIV populations. This manuscript reviews recent data for the vaccines most commonly administered in HIV patients and incorporates these data into our body of knowledge about the safety and efficacy of vaccines in this population. In addition, patient factors that predict response for each vaccine are discussed. Given the great burden of human papillomavirus and herpes zoster in HIV patients, we discuss the benefits and the challenges of vaccinating HIV patients with the human papillomavirus and herpes zoster vaccines. This review provides information that clinicians need to make real-time decisions in the absence of large-scale trials in the HIV population. PMID:23681435

  16. Orbital Apex Syndrome in Herpes Zoster Ophthalmicus

    PubMed Central

    Arda, Hatice; Mirza, Ertugrul; Gumus, Koray; Oner, Ayse; Karakucuk, Sarper; Sırakaya, Ender

    2012-01-01

    Orbital apex syndrome is a rare manifestation of Herpes Zoster Ophthalmicus. Herein we report on a case of orbital apex syndrome secondary to Herpes Zoster Ophthalmicus. A 75 year-old male complained of vision loss, conjunctival hyperemia and proptosis on the left eye, was referred to our clinic. Visual acuity was 5/10 Snellen lines and he had conjunctival hyperemia, chemosis, minimal nuclear cataract and proptosis on the left eye. A diagnosis of orbital pseudotumor was demonstrated firstly. The patient received oral and topical corticosteroids, antiinflammatory and antibiotic agents. On day 2, vesiculopustular lesions were observed, Herpes Zoster Ophthalmicus was diagnosed and corticosteroid treatment stopped, oral acyclovir treatment initiated. Two days later, total ophthalmoplegia, ptosis and significant visual loss were observed on the left. The diagnosis of orbital apex syndrome was considered and the patient commenced on an intravenous acyclovir treatment. After the improvement of acute symptoms, a tapering dose of oral cortisone treatment initiated to accelarate the recovery of ophthalmoplegia. At 5-month follow-up, ptosis and ocular motility showed improvement. VA did not significantly improve because of cataract and choroidal detachment on the left. We conclude that ophthalmoplegia secondary to Herpes Zoster Ophthalmicus responds favourably to intravenous acyclovir and steroids. PMID:22830066

  17. A case of almost painless herpes zoster presenting with symptoms of cystitis, penile numbness, and acute vestibular failure.

    PubMed

    Al-Sardar, Hussain

    2013-01-01

    Herpes zoster (shingles) is an acute, painful, vesicular, and cutaneous eruption caused by varicella zoster virus, the same virus which causes chicken pox. It is due to the reactivation of the virus which remains dormant in sensory ganglions following chicken pox. It is usually confined to a single dermatome but may involve 2-3 dermatomes. Typically, it is a unilateral lesion which can affect both cranial and peripheral nerves. It is usually a self-limiting disease; however, it may cause significant morbidity especially in the elderly. It is more common in older people and individuals with immunocompromised conditions. Antiviral drugs can shorten the duration and the severity of the illness and need to be started as soon as possible after the appearance of the rash. Gabapentin and tricyclic antidepressant are effective in postherpetic neuralgia. Vaccine can reduce the risk of infection and its associated pain. Typically, it occurs once in a lifetime, but some individuals may have more than one episode. PMID:24251046

  18. Comparative preclinical evaluation of AS01 versus other Adjuvant Systems in a candidate herpes zoster glycoprotein E subunit vaccine

    PubMed Central

    Fochesato, Michel; Dendouga, Najoua; Boxus, Mathieu

    2016-01-01

    ABSTRACT The candidate vaccine HZ/su is being developed to prevent herpes-zoster disease (HZ). HZ occurrence is attributed to declines in varicella-zoster virus (VZV) specific T-cell immunity. HZ/su contains VZV antigen, gE, and Adjuvant System AS01B (liposome-based formulation of MPL and QS-21). In clinical trials, AS01B enhances CD4+ T-cell responses to gE. In clinical trials of other vaccines, Adjuvant Systems AS03 and AS04 also enhance antigen-specific CD4+ T-cell responses. Hence the purpose of this study was to evaluate gE formulated with AS01B, AS01E (50% less MPL and QS-21 than AS01B), AS03 or AS04 in C57BL6 mice primed with live-attenuated VZV. Four-weeks post-vaccination, the gE-specific CD4+ T-cell response to gE/AS01B was 5.4, 2.8 and 2.2-fold greater than those to gE/AS03, gE/AS04 and gE/AS03, respectively (p<0.001). Therefore in the VZV-primed mouse model, CD4+ T-cell responses to gE appeared most enhanced by AS01B, and adds further support for the use of AS01B in the HZ/su formulation. PMID:26933767

  19. The Incidence and Risk of Herpes Zoster in Patients With Sleep Disorders

    PubMed Central

    Chung, Wei-Sheng; Lin, Hsuan-Hung; Cheng, Nan-Cheng

    2016-01-01

    Abstract Lack of sleep can compromise the immune system, which may reactivate latent varicella-zoster virus. Studies on sleep disorders and the risk of herpes zoster (HZ) are scant. We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development. We identified patients with sleep disorders without apnea from 2002 to 2005 by using the Taiwan Longitudinal Health Insurance Database. The patients without sleep disorders were randomly selected and frequency matched with patients with sleep disorders according to age, sex, and index year. We estimated the follow-up time in person-years for the patients from the entry date until HZ diagnosis, loss to follow-up, or the end of 2010. We used Cox proportional hazards regression models and a sensitivity analysis to estimate the risk of HZ while controlling for demographic characteristics and comorbidities. A total of 131,001 study participants (follow-up, 948,177 person-years; mean age, 51.2 ± 16.5 years; 62.2% women) were included in the study. Patients with sleep disorders exhibited a higher incidence of HZ compared with a comparison cohort when stratified by age, sex, and comorbidities. After adjustment for covariates, the sleep disorder cohort exhibited a 1.23-fold greater risk of HZ compared with the comparison cohort (95% confidence interval [CI] = 1.17–1.30). The incidence of HZ increased with age. Adults ages 65 years and older exhibited a 6.11-fold greater risk of HZ development compared with their younger counterparts (95% CI = 5.34–7.00). Cancers and autoimmune diseases were independent risk factors of HZ development. The patients with sleep disorders may carry an increased risk of developing HZ. PMID:26986095

  20. The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia.

    PubMed

    Brisson, Marc; Pellissier, James M; Camden, Stéphanie; Quach, Caroline; De Wals, Philippe

    2008-01-01

    A clinical trial has shown that a live-attenuated varicella-zoster virus vaccine is effective against herpes zoster (HZ) and post-herpetic neuralgia (PHN). The aim of this study was to examine the cost-effectiveness of vaccination against HZ and PHN in Canada. A cohort model was developed to estimate the burden of HZ and the cost-effectiveness of HZ vaccination, using Canadian population-based data. Different ages at vaccination were examined and probabilistic sensitivity analysis was performed. The economic evaluation was conducted from the ministry of health perspective and 5% discounting was used for costs and benefits. In Canada (population = 30 million), we estimate that each year there are 130,000 new cases of HZ, 17,000 cases of PHN and 20 deaths. Most of the pain and suffering is borne by adults over the age of 60 years and is due to PHN. Vaccinating 65-year-olds (HZ efficacy = 63%, PHN efficacy = 67%, no waning, cost/course = $150) is estimated to cost $33,000 per QALY-gained (90% CrI: 19,000-63,000). Assuming the cost per course of HZ vaccination is $150, probabilistic sensitivity analysis suggest that vaccinating between 65 and 75 years of age will likely yield cost-effectiveness ratios below $40,000 per Quality-Adjusted Life-Year (QALY) gained, while vaccinating adults older than 75 years will yield ratios less than $70,000 per QALY-gained. These results are most sensitive to the duration of vaccine protection and the cost of vaccination. In conclusion, results suggest that vaccinating adults between the ages of 65 and 75 years is likely to be cost-effective and thus to be a judicious use of scarce health care resources. PMID:18382137

  1. Varicella paediatric hospitalisations in Belgium: a 1-year national survey

    PubMed Central

    Blumental, Sophie; Sabbe, Martine; Lepage, Philippe

    2016-01-01

    Background Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. Methods Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. Results Participation of 101 hospitals was obtained, covering 97.7% of the total paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/105 person-years, with the highest impact among those 0–4 years old (global incidence and odds of hospitalisation: 79/105 person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had ≥1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/105 person-years. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric population was 0.5/106 and fatality ratio 0.2% among our cohort. Conclusions Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium. PMID:26130380

  2. National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia

    PubMed Central

    Murray, Sara G.; Schmajuk, Gabriela; Trupin, Laura; Gensler, Lianne; Katz, Patricia P.; Yelin, Edward H.; Gansky, Stuart A.; Yazdany, Jinoos

    2016-01-01

    Objective Infection is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE). Therapeutic practices have evolved over the past 15 years, but effects on infectious complications of SLE are unknown. We evaluated trends in hospitalizations for severe and opportunistic infections in a population-based SLE study. Methods Data derive from the 2000 to 2011 United States National Inpatient Sample, including individuals who met a validated administrative definition of SLE. Primary outcomes were diagnoses of bacteremia, pneumonia, opportunistic fungal infection, herpes zoster, cytomegalovirus, or pneumocystis pneumonia (PCP). We used Poisson regression to determine whether infection rates were changing in SLE hospitalizations and used predictive marginals to generate annual adjusted rates of specific infections. Results We identified 361,337 SLE hospitalizations from 2000 to 2011 meeting study inclusion criteria. Compared to non-SLE hospitalizations, SLE patients were younger (51 vs. 62 years), predominantly female (89% vs. 54%), and more likely to be racial/ethnic minorities. SLE diagnosis was significantly associated with all measured severe and opportunistic infections. From 2000 to 2011, adjusted SLE hospitalization rates for herpes zoster increased more than non-SLE rates: 54 to 79 per 10,000 SLE hospitalizations compared with 24 to 29 per 10,000 non-SLE hospitalizations. Conversely, SLE hospitalizations for PCP disproportionately decreased: 5.1 to 2.5 per 10,000 SLE hospitalizations compared with 0.9 to 1.3 per 10,000 non-SLE hospitalizations. Conclusions Among patients with SLE, herpes zoster hospitalizations are rising while PCP hospitalizations are declining. These trends likely reflect evolving SLE treatment strategies. Further research is needed to identify patients at greatest risk for infectious complications. PMID:26731012

  3. Shingles (Herpes Zoster) Vaccine (Zostavax(®)): A Review in the Prevention of Herpes Zoster and Postherpetic Neuralgia.

    PubMed

    Keating, Gillian M

    2016-06-01

    Zostavax(®) is a live attenuated shingles (herpes zoster) vaccine approved in the EU for the prevention of herpes zoster (HZ) and postherpetic neuralgia (PHN) in adults aged ≥50 years. Zoster vaccine protected against HZ in adults aged 50-59 years (ZEST trial) and ≥60 years [Shingles Prevention Study (SPS)], and also reduced the burden of illness associated with HZ and the risk of PHN in adults aged ≥60 years (SPS). A large amount of real-world data also supports the efficacy of zoster vaccine. Results of the SPS Short- and Long-Term Persistence Substudies and real-world studies indicate that zoster vaccine provided continued benefit in the longer term, albeit with a gradual decline in vaccine efficacy over time; long-term effectiveness studies are ongoing. The need for a booster dose is still unknown, but a study showed that, if necessary, a booster dose administered to adults aged ≥70 years who received their first dose of zoster vaccine ≥10 years previously was immunogenic. Zoster vaccine had a favourable safety and tolerability profile, with the most commonly reported adverse events being non-severe injection-site reactions. In conclusion, zoster vaccine reduces the incidence of HZ and PHN, thereby reducing the burden of illness associated with HZ; improved uptake of zoster vaccine is needed. PMID:27189459

  4. Two-dose Varicella Vaccine Effectiveness and Rash Severity in Outbreaks of Varicella Among Public School Students

    PubMed Central

    Thomas, Carrie A.; Shwe, Thein; Bixler, Dee; del Rosario, Maria; Grytdal, Scott; Wang, Chengbin; Haddy, Loretta E.; Bialek, Stephanie R.

    2015-01-01

    Background Universal 2-dose varicella vaccination was recommended in 2006 to further reduce varicella disease burden. This study examined 2-dose varicella vaccine effectiveness (VE) and rash severity in the setting of school-associated varicella outbreaks. Methods A case control study was conducted from January 2010 to May 2011 in all West Virginia public schools. Clinically diagnosed cases from varicella outbreaks were matched with classmate controls. Vaccination information was collected from school, health department and healthcare provider immunization information systems. Results Among the 133 cases and 365 controls enrolled, VE against all varicella was 83.2% [95% confidence interval (CI): 69.2%–90.8%] for 1-dose of varicella vaccine and 93.9% (95% CI: 86.9%–97.1%) for 2-dose; the incremental VE (2-dose vs. 1-dose) was 63.6% (95% CI: 32.6%–80.3%). In preventing moderate/severe varicella, 1-dose varicella vaccine was 88.2% (95% CI: 72.7%– 94.9%) effective, and 2-dose vaccination was 97.5% (95% CI: 91.6%–99.2%) effective, with the incremental VE of 78.6% (95% CI: 40.9%–92.3%). One-dose VE declined along with time since vaccination (VE = 93.0%, 88.0% and 81.8% in <5, 5–9 and ≥10 years after vaccination, P = 0.001 for trend). Both 1- and 2-dose breakthrough cases had milder rash than unvaccinated cases (<50 lesion: 24.6%, 49.1% and 70.0% in unvaccinated, 1-dose and 2-dose cases, P < 0.001), and no severe disease was found in 2-dose cases. Conclusions Two-dose varicella vaccination is highly effective and confers higher protection than a 1-dose regimen. High 2-dose varicella vaccination coverage should maximize the benefits of the varicella vaccination program and further reduce varicella disease burden in the United States. PMID:24911894

  5. Granuloma annulare in herpes zoster scars.

    PubMed

    Ohata, C; Shirabe, H; Takagi, K; Kawatsu, T

    2000-03-01

    A 54-year-old Japanese female developed granuloma annulare twice in herpes zoster scars. Soon after the second event, she developed ulcerative colitis, which was well controlled by sulfonamides and corticosteroid suppository. She had no history of diabetes mellitus. There was no recurrence of granuloma annulare by June of 1999. Granuloma annulare might have contributed to the complications of ulcerative colitis, although this had not been noticed before. PMID:10774142

  6. [Treatment of herpes zoster and postherpetic neuralgia].

    PubMed

    Schulzeck, Sabine; Gleim, Martin

    2009-10-01

    Herpes zoster, a biphasic disease with different kinds of pain is a challenge for pain therapy. The acute illness with mixed pain (nociceptive - neuropathic) requires antivirals for risk patients and pain treatment according to rules of acute pain therapy. For treatment of postherpetic neuralgia (PHN) an example of neuropathic pain, antidepressants, anticonvulsants and topical lidocaine are today the first line therapeutics, further opioids are of a certain therapeutic value. PMID:19834828

  7. Asthma and risk of breakthrough varicella infection in children

    PubMed Central

    Umaretiya, Puja J.; Swanson, Jennifer B.; Kwon, Hyo-Jin; Grose, Charles; Lohse, Christine M.

    2016-01-01

    Background: We recently reported a more rapid waning of vaccine-induced humoral immunity (measles vaccine) in children with asthma. It is unknown if asthma affects susceptibility to vaccine-preventable diseases. Objective: To determine whether asthma is associated with an increased risk of vaccine-preventable disease, e.g., breakthrough varicella infection. Methods: This was a retrospective population-based case-control study that examined cases of breakthrough varicella among children between 2005 and 2011. Children with a diagnosis of breakthrough varicella infection in Olmsted County, Minnesota (infection of >42 days after vaccination) between 2005 and 2011 and two age- and sex-matched controls were enrolled for each case. Asthma status was determined by using predetermined criteria. Conditional logistic regression models were used to calculate matched odds ratios (OR) and their corresponding 95% confidence intervals (CI). Results: Of the 165 cases and their 330 matched controls, 48% were boys and the mean (standard deviation) age at the index date was 6.6 ± 3.5 years for both cases and controls. Of the 330 controls, 80 (24%) had two doses of the varicella vaccine compared with only 23 (14%) of the 165 cases (OR 0.29 [95% CI, 0.14–0.61]; p = 0.001). Children with a history of asthma ever had a higher risk of developing breakthrough varicella compared with those without a history of asthma (adjusted OR 1.63 [95% CI, 1.04–2.55]; p = 0.032) when adjusting for elapsed time since the first varicella vaccination and the number of varicella vaccine doses. Conclusions: A history of asthma might be an unrecognized risk factor for breakthrough varicella infection. Children with asthma should follow the two-dose varicella vaccine policy. PMID:27178889

  8. Abdominal muscle paralysis associated with herpes zoster.

    PubMed

    Gottschau, P; Trojaborg, W

    1991-10-01

    We describe a 77-year-old women with cutaneous herpes zoster in the area of the right T9-T11 dermatomes complicated by abdominal muscle paralysis. Four months after onset of paralysis, stimulation of appropriate intercostal nerves failed to evoke responses from the corresponding segments of the rectus abdominis muscle. Three months later EMG of these muscle segments revealed profuse denervation activity and spontaneous long-lasting burst of high frequency discharges. Magnetic stimulation applied transcranially and peripherally at T10 evoked responses from the left, but not from the right paralytic rectus abdominis muscle. Electric stimulation of right T10 elicited a markedly delayed, prolonged and polyphasic response in the transverse abdominis muscle and EMG revealed polyphasia and increased motor unit potential duration in muscle segments underlying herpes zoster eruption. One and a half years after onset, the paralysis of the rectus abdominis muscle was still present. A survey of the literature concerning this rare type of zoster paralysis is presented. PMID:1837649

  9. Chickenpox (varicella) vaccine - what you need to know

    MedlinePlus

    ... vaccine called MMRV, which contains both chickenpox and MMR vaccines, may be given instead of the two individual ... with rash and higher rates of fever than MMR and varicella vaccines given separately. Rash has been reported in about ...

  10. Chickenpox (varicella) vaccine - what you need to know

    MedlinePlus

    ... is taken in its entirety from the CDC Chickenpox Vaccine Information Statement (VIS): www.cdc.gov/vaccines/ ... statements/varicella.html CDC review information for the Chickenpox VIS: Page last reviewed: June 13, 2014 Page ...

  11. Infectious Arthritis

    MedlinePlus

    Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Infectious arthritis is an infection in the joint. The infection ...

  12. [Life threatening secondary bacterial infection of varicella skin lesions].

    PubMed

    Resch, Elisabeth; Ihm, Ulrike; Haslinger, Vera; Wagner, Thomas; Kurz, Herbert

    2012-04-01

    As immunization coverage of varicella vaccination is low, the disease is still very frequent in Austria. Albeit the prognosis in general is good, the incidence of varicella-related hospitalization is about 6 per 100,000 in all children between 0-15 years of age, affecting mainly previously healthy children. Especially young children under the age of 5 are at risk with highest rates among children younger than one year. The most common complications are secondary bacterial infections, neurological and respiratory complications. Two cases of life threatening secondary bacterial infection are presented. One child suffered from a Toxic Shock Syndrome caused by group A streptococcus along with large necrotizing skin lesions. The second child nearly lost her left eye due to a deep orbital abscess. Both children survived without severe sequelae but had to undergo several procedures of plastic surgery. Implementation of the varicella vaccination program in the USA has shown a near elimination of deaths due to severe varicella complications. The initiation of the varicella vaccination program for children until the age of 2 in Austria should be considered to prevent complications and deaths caused by varicella. PMID:22614542

  13. Varicella routine vaccination and the effects on varicella epidemiology – results from the Bavarian Varicella Surveillance Project (BaVariPro), 2006-2011

    PubMed Central

    2013-01-01

    Background In 2004, routine varicella vaccination was recommended in Germany for children 11-14 months of age with one dose, and since 2009, with a second dose at 15-23 months of age. The effects on varicella epidemiology were investigated. Methods Data on varicella vaccinations, cases and complications were collected from annual parent surveys (2006-2011), monthly paediatric practice surveillance (Oct 2006 - Sep 2011; five varicella seasons) and paediatric hospital databases (2005-2009) in the area of Munich (about 238,000 paediatric inhabitants); annual incidences of cases and hospitalisations were estimated. Results Varicella vaccination coverage (1st dose) in children 18-36 months of age increased in two steps (38%, 51%, 53%, 53%, 66% and 68%); second-dose coverage reached 59% in the 2011 survey. A monthly mean of 82 (62%) practices participated; they applied a total of 50,059 first-dose and 40,541 second-dose varicella vaccinations, with preferential use of combined MMR-varicella vaccine after recommendation of two doses, and reported a total of 16,054 varicella cases <17 years of age. The mean number of cases decreased by 67% in two steps, from 6.6 (95%CI 6.1-7.0) per 1,000 patient contacts in season 2006/07 to 4.2 (95%CI 3.9-4.6) in 2007/08 and 4.0 (95%CI 3.6-4.3) in 2008/09, and further to 2.3 (95%CI 2.0-2.6) in 2009/10 and 2.2 (95%CI 1.9-2.5) in 2010/11. The decrease occurred in all paediatric age groups, indicating herd protection effects. Incidence of varicella was estimated as 78/1,000 children <17 years of age in 2006/07, and 19/1,000 in 2010/11. Vaccinated cases increased from 0.3 (95%0.2-0.3) per 1,000 patient contacts in 2006/07 to 0.4 (95%CI 0.3-0.5) until 2008/09 and decreased to 0.2 (95%CI 0.2-0.3) until 2010/11. The practices treated a total of 134 complicated cases, mainly with skin complications. The paediatric hospitals recorded a total of 178 varicella patients, including 40 (22.5%) with neurological complications and one (0.6%) fatality due

  14. The Incidence and Risk of Herpes Zoster in Patients With Sleep Disorders: A Population-Based Cohort Study.

    PubMed

    Chung, Wei-Sheng; Lin, Hsuan-Hung; Cheng, Nan-Cheng

    2016-03-01

    Lack of sleep can compromise the immune system, which may reactivate latent varicella-zoster virus. Studies on sleep disorders and the risk of herpes zoster (HZ) are scant.We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development. We identified patients with sleep disorders without apnea from 2002 to 2005 by using the Taiwan Longitudinal Health Insurance Database. The patients without sleep disorders were randomly selected and frequency matched with patients with sleep disorders according to age, sex, and index year. We estimated the follow-up time in person-years for the patients from the entry date until HZ diagnosis, loss to follow-up, or the end of 2010. We used Cox proportional hazards regression models and a sensitivity analysis to estimate the risk of HZ while controlling for demographic characteristics and comorbidities. A total of 131,001 study participants (follow-up, 948,177 person-years; mean age, 51.2 ± 16.5 years; 62.2% women) were included in the study. Patients with sleep disorders exhibited a higher incidence of HZ compared with a comparison cohort when stratified by age, sex, and comorbidities. After adjustment for covariates, the sleep disorder cohort exhibited a 1.23-fold greater risk of HZ compared with the comparison cohort (95% confidence interval [CI] = 1.17-1.30). The incidence of HZ increased with age. Adults ages 65 years and older exhibited a 6.11-fold greater risk of HZ development compared with their younger counterparts (95% CI = 5.34-7.00). Cancers and autoimmune diseases were independent risk factors of HZ development. The patients with sleep disorders may carry an increased risk of developing HZ. PMID:26986095

  15. The VZV/IE63-specific T cell response prevents herpes zoster in fingolimod-treated patients

    PubMed Central

    Mathias, Amandine; Perriard, Guillaume; Canales, Mathieu; Vuilleumier, Fanny; Perrotta, Gaetano; Schluep, Myriam

    2016-01-01

    Objective: To assess longitudinally the antiviral immune response of T cells from patients with multiple sclerosis (MS) treated with fingolimod (FTY) vs other disease-modifying treatments (DMTs). Methods: We assessed cellular immune responses specific to influenza virus (FLU), JC virus (JCV), and varicella-zoster virus (VZV) using quantification of interferon-γ secretion by enzyme-linked immunospot in patients with MS on FTY (n = 31), including 2 with herpes zoster (HZ), natalizumab (n = 11), and other DMTs (n = 11). We used viral lysates for FLU and VZV and a pool of peptides for FLU, JCV (VP-1), and VZV (IE63). Results: Besides an expected drop of T cells, we found that, proportionally to the number of CD3+ T cells, only FTY-treated patients with MS exhibited an increased VZV/IE63-specific T cell response peaking 6 months into treatment, a response that returned to baseline after 12 and 24 months. Two FTY-treated patients developed an HZ 6 months into treatment, coinciding with an absent VZV/IE63-specific T cell response. However, cellular immune responses specific to VZV lysate, JCV, and FLU (lysate and pool of peptide epitopes) were similar between all 3 categories (FTY, natalizumab, and other DMTs) of study patients. Conclusions: FTY-treated patients with MS exhibit an increased VZV/IE63-specific cellular immune response after 6 months of treatment. FTY-treated patients who develop an HZ are not able to mount such a response, suggesting that a T cell response directed against this viral protein may be key in preventing the occurrence of HZ. PMID:26913291

  16. Trends in varicella mortality in the United States: Data from vital statistics and the national surveillance system

    PubMed Central

    Leung, Jessica; Bialek, Stephanie R; Marin, Mona

    2015-01-01

    This manuscript describes trends in US varicella mortality using national vital statistics system data for 2008–2011, the first years of the routine 2-dose varicella vaccination program, and characteristics of varicella deaths reported to CDC during 1996–2013. We obtained data on deaths with varicella as underlying or contributing cause from the 2008–2011 Mortality Multiple Cause-of Death records and calculated rates to compare with the prevaccine and mature 1-dose varicella vaccination program eras. We also reviewed available records of varicella deaths reported to CDC through the national varicella death surveillance. The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.05 per million population during 2008–2011, an 87% reduction from the prevaccine years. Varicella deaths among persons aged <20 y declined by 99% in 2008–2011 compared with prevaccine years. There was a 70% decline in varicella mortality rates among those <20 y in 2008–2011 compared to 2005–2007. Among the 83 deaths reported to CDC during 1996–2013 classified as likely due to varicella, 24 (29%) were among immunocompromised individuals. Five were among persons previously vaccinated with 1 dose of varicella vaccine. In conclusion, although the US varicella vaccination program has significantly reduced varicella disease burden, there are still opportunities to prevent varicella and its associated morbidity and mortality through routine varicella vaccination, catch-up vaccination, and ensuring that household contacts of immunocompromised persons have evidence of immunity. PMID:25714052

  17. Trends in varicella mortality in the United States: Data from vital statistics and the national surveillance system.

    PubMed

    Leung, Jessica; Bialek, Stephanie R; Marin, Mona

    2015-01-01

    This manuscript describes trends in US varicella mortality using national vital statistics system data for 2008-2011, the first years of the routine 2-dose varicella vaccination program, and characteristics of varicella deaths reported to CDC during 1996-2013. We obtained data on deaths with varicella as underlying or contributing cause from the 2008-2011 Mortality Multiple Cause-of Death records and calculated rates to compare with the prevaccine and mature 1-dose varicella vaccination program eras. We also reviewed available records of varicella deaths reported to CDC through the national varicella death surveillance. The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.05 per million population during 2008-2011, an 87% reduction from the prevaccine years. Varicella deaths among persons aged <20 y declined by 99% in 2008-2011 compared with prevaccine years. There was a 70% decline in varicella mortality rates among those <20 y in 2008-2011 compared to 2005-2007. Among the 83 deaths reported to CDC during 1996-2013 classified as likely due to varicella, 24 (29%) were among immunocompromised individuals. Five were among persons previously vaccinated with 1 dose of varicella vaccine. In conclusion, although the US varicella vaccination program has significantly reduced varicella disease burden, there are still opportunities to prevent varicella and its associated morbidity and mortality through routine varicella vaccination, catch-up vaccination, and ensuring that household contacts of immunocompromised persons have evidence of immunity. PMID:25714052

  18. Similar herpes zoster incidence across Europe: results from a systematic literature review

    PubMed Central

    2013-01-01

    Background Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ≥50 years. The forthcoming European launch of a vaccine against HZ (Zostavax®) prompts the need for a better understanding of the epidemiology of HZ in Europe. Therefore the aim of this systematic review was to summarize the available data on HZ incidence in Europe and to describe age-specific incidence. Methods The Medline database of the National Library of Medicine was used to conduct a comprehensive literature search of population-based studies of HZ incidence published between 1960 and 2010 carried out in the 27 member countries of the European Union, Iceland, Norway and Switzerland. The identified articles were reviewed and scored according to a reading grid including various quality criteria, and HZ incidence data were extracted and presented by country. Results The search identified 21 studies, and revealed a similar annual HZ incidence throughout Europe, varying by country from 2.0 to 4.6/1 000 person-years with no clearly observed geographic trend. Despite the fact that age groups differed from one study to another, age-specific HZ incidence rates seemed to hold steady during the review period, at around 1/1 000 children <10 years, around 2/1 000 adults aged <40 years, and around 1–4/1 000 adults aged 40–50 years. They then increased rapidly after age 50 years to around 7–8/1 000, up to 10/1 000 after 80 years of age. Our review confirms that in Europe HZ incidence increases with age, and quite drastically after 50 years of age. In all of the 21 studies included in the present review, incidence rates were higher among women than men, and this difference increased with age. This review also highlights the need to identify standardized surveillance methods to improve the comparability of data within European Union Member States and to monitor the impact of VZV immunization on the epidemiology of HZ. Conclusions

  19. Morphea Developing at the Site of Healed Herpes Zoster

    PubMed Central

    Noh, Tae Woo; Park, Sang Hoon; Kang, Yoo Seok; Lee, Un Ha; Jang, Sang Jai

    2011-01-01

    Wolf's isotopic response describes the occurrence of a new, unrelated disease that appears at the same location as a previously healed skin disease, and the most common primary skin disease of this phenomenon is herpes zoster. Several cutaneous lesions have been described to occur at the site of healed herpes zoster, and granulomatous dermatitis and granuloma annulare have been reported to be the most common second diseases. The pathogenesis of the isotopic response is still unclear. Morphea can develop at the site of regressed herpes zoster and a few such cases have been reported. We present here an additional case of morphea that developed at the site of previously healed herpes zoster, and we review the relevant literature. PMID:21747631

  20. Infectious Arthritis

    MedlinePlus

    ... Another form of reactive arthritis starts with eating food or handling something that has bacteria on it. To diagnose infectious arthritis, your health care provider may do tests of your blood, urine, and joint fluid. Treatment includes medicines and sometimes surgery.

  1. PREVALENCE OF ANTIBODIES TO ENTEROVIRUSES AND VARICELLA-ZOSTER VIRUS AMONG RESIDENTS AND OVERSEAS VOLUNTEERS AT AGRICULTURAL SETTLEMENTS IN ISRAEL

    EPA Science Inventory

    The aim of the study was to determine the susceptibility of a presumably high risk population to infections caused by viruses with different modes of transmission. For this purpose, the prevalence of antibodies to several viruses was determined among overseas volunteers upon thei...

  2. Blinded search for varicella zoster virus in giant cell arteritis (GCA)-positive and GCA-negative temporal arteries.

    PubMed

    Gilden, Don; White, Teresa; Khmeleva, Nelly; Katz, Bradley J; Nagel, Maria A

    2016-05-15

    Recent analysis of archived temporal arteries (TAs) acquired from 13 pathology laboratories in the US, Canada, Iceland, France, Germany and Israel from patients with pathologically-verified giant cell arteritis (GCA-positive) and TAs from patients with clinical features and laboratory abnormalities of GCA but whose TAs were pathologically negative (GCA-negative) revealed VZV antigen in most TAs from both groups. Despite formalin-fixation, VZV DNA was also found in many VZV-antigen positive sections that were scraped, subjected to DNA extraction, and examined by PCR with VZV-specific primers. Importantly, in past studies, the pathological diagnosis (GCA-positive or -negative) was known to the neurovirology laboratory. Herein, GCA-positive and GCA-negative TAs were provided by an outside institution and examined by 4 investigators blinded to the pathological diagnoses. VZV antigen was found in 3/3 GCA-positive TAs and in 4/6 GCA-negative TAs, and VZV DNA in 1/3 VZV antigen-positive, GCA-positive TAs and in 3/4 VZV antigen-positive, GCA-negative TAs. VZV DNA was also detected in one GCA-negative, VZV-antigen negative TA. Overall, the detection of VZV antigen in 78% of GCA-positive and GCA-negative TAs is consistent with previous reports on the prevalence of VZV antigen in patients with clinically suspect GCA. PMID:27084233

  3. Varicella surveillance and policy in the United States and Minnesota.

    PubMed

    Murray, Andrew

    2007-12-01

    An estimated 82.7% of Minnesota children 19 months to 35 months of age were vaccinated against varicella in 2006 as a result of accepted national recommendations, provider education, and vaccination mandates. Despite the wide-ranging acceptance of vaccination, outbreaks of varicella continue to occur in schools and childcare centers, even those with a high percentage of vaccinated children. As a result, national recommendations have been modified to include a universal second dose of vaccine. Starting in September 2008, students entering kindergarten or 7th grade in Minnesota will be required to provide documentation of having had 2 doses of varicella vaccine, a history of the disease, or legal exemption. PMID:18196780

  4. Localized Eruptive Blue Nevi after Herpes Zoster

    PubMed Central

    Colson, Fany; Arrese, Jorge E.; Nikkels, Arjen F.

    2016-01-01

    A 52-year-old White man presented with a dozen small, well-restricted, punctiform, asymptomatic, blue-gray macules on the left shoulder. A few months earlier, he had been treated with oral acyclovir for herpes zoster (HZ) affecting the left C7–C8 dermatomes. All the blue macules appeared over a short period of time and then remained stable. The patient had not experienced any previous trauma or had tattooing in this anatomical region. The clinical diagnosis suggested blue nevi. Dermatoscopy revealed small, well-limited, dark-blue, compact, homogeneous areas evoking dermal blue nevi. An excisional biopsy was performed and the histological examination confirmed a blue nevus. As far as we are aware of, this is the first report of eruptive blue nevi following HZ, and it should be included in the differential diagnosis of zosteriform dermatoses responding to an isotopic pathway. In addition, a brief review concerning eruptive nevi is presented. PMID:27462219

  5. Herpes zoster ophthalmicus associated with abducens palsy

    PubMed Central

    Chaker, Nibrass; Bouladi, Mejda; Chebil, Ahmed; Jemmeli, Mehdi; Mghaieth, Fatma; El Matri, Leila

    2014-01-01

    The extraocular muscle palsies associated with herpes zoster ophthalmicus (HZO) are transient, self-limiting conditions, usually seen in elderly patients. There are different treatment recommendations for paralytic complications, but prognosis has generally reported to be favorable. A 75-year-old male patient presented with diplopia. Clinical history revealed left facial vesicular eruptions and pain treated by oral aciclovir 1 week following symptom onset. On examination, we observed cicatricial lesions with crusts involving left hemiface, a limitation in abduction of the left eye, and a superficial punctuate keratitis (SPK) with decreased visual acuity (4/10). Examination of the right eye was unremarkable. Hess screen test confirmed left six nerve palsy. PMID:24966563

  6. Infectious disease.

    PubMed

    Jaworski, Carrie A; Donohue, Brian; Kluetz, Joshua

    2011-07-01

    Athletes are susceptible to the same infections as the general population. However, special considerations often need to be taken into account when dealing with an athlete who has contracted an infectious disease. Health care providers need to consider how even common illnesses can affect an athlete's performance, the communicability of the illness to team members, and precautions/contraindications related to athletic participation. Recent advances in the prevention, diagnosis, and/or management of frequently encountered illnesses, as well as certain conditions that warrant special attention in the athletic setting, are discussed in detail. PMID:21658549

  7. Economic evaluation of Varicella vaccination: results of a systematic review

    PubMed Central

    Unim, Brigid; Saulle, Rosella; Boccalini, Sara; Taddei, Cristina; Ceccherini, Vega; Boccia, Antonio; Bonanni, Paolo; La Torre, Giuseppe

    2013-01-01

    Introduction: The aim of the present study is to review the economic burden of varicella disease and the benefit of universal varicella vaccination in different settings pending its implementation in all Italian regions. Materials and Methods: Research was conducted using PubMed, Scopus and ISI databases. Score quality and data extraction were performed for all included studies. Results: Twenty-three articles met the criteria: 15 cost-effectiveness, 8 cost-benefit and one cost-utility analysis. Varicella vaccination could save the society from €637,762 (infant strategy) to 53 million annually (combined infant and adolescent strategy). The median and the mean quality scores resulted in 91.8% and 85.4% respectively; 11 studies were considered of high quality and 12 of low quality. Discussion: The studies are favorable to the introduction of universal varicella vaccination in Italy, being cost saving and having a positive impact on morbidity. The quality score of the studies varied greatly: recent analyses were of comparable quality to older studies. PMID:23823940

  8. Two contrasting post-zoster dermatomal phenomena.

    PubMed

    Sultan, Sheikh Javeed; Sameem, Farah

    2012-01-01

    A 29-year-old, normotensive, nondiabetic man presented with a 9-day history of a scaly, pruritic eruption involving the right chest, axilla, and arm. He had a history of herpes zoster involving the same areas about 4 weeks ago. The present eruption started after the herpetic lesions had healed. Examination revealed scaly, erythematous plaques and papules involving the right side of the chest, axilla, and arm in a dermatomal pattern (figure 1). Removal of the scales revealed underlying bleeding points (positive Auspitz sign). The rest of the body, including scalp, palms, soles, and nails, were normal. There was no history suggestive of psoriasis in any family member. Systemic examination and routine investigations were noncontributory. A clinical diagnosis of psoriasis was made and confirmed by histopathologic examination of a skin biopsy sample. The patient was prescribed a topical clobetasol cream and oral levocetirizine. The eruption resolved completely after 3 weeks. A 43-year-old normotensive, nondiabetic woman presented with a 2-day history of fever, arthalgias, and generalized erythematous dermatitis. Five days ago, the patient had a toothache for which she was prescribed injectable ampicillin. After receiving ampicillin for 3 days, she developed fever, myalgias, and arthalgias, which was followed several hours later by an erythematous eruption. The dermatitis started on the trunk and, over a period of several hours, progressed to involve the face and limbs. The eruption was slightly pruritic. History revealed herpes zoster 7 months ago involving left thoracic dermatomes, for which the patient was treated with valacyclovir (1 g thrice a day x 7 days) and analgesics. There was no history of post-zoster neuralgia. On examination, the patient was febrile (oral temperature 102 degrees F), her heart rate was 118 beats per minute, and her blood pressure was 110/70 mm Hg. Cutaneous examination revealed an erythematous, maculopapular dermatitis involving the face and

  9. Efficacy of continuous epidural block in acute herpes zoster

    PubMed Central

    Kim, Yoo Na; Kim, Dae Woo; Kim, Eung Don

    2016-01-01

    Abstract The aim of the present study was to investigate efficacy of continuous epidural block for prevent postherpetic neuralgia (PHN) progression in cases of acute herpes zoster with severe pain and also to identify predictive factors for PHN in such conditions. We retrospectively analyzed the clinical data of patients with herpes zoster who underwent continuous epidural block between March 2013 and October 2015. Time points were set as 1 month, 3 months, and 6 months after zoster onset. PHN was defined as the presence of pain with NRS ≥3 at certain time points. The incidence of developing PHN was 38.1%, 27.0%, and 19.0% 1 month, 3 months, and 6 months after zoster onset, respectively. Age and duration of catheterization were predictive factors for PHN at 1 month. Age, duration of catheterization, and NRS at first visit were identified as predictive factors for PHN at 3 months. Presence of diabetes, duration of catheterization, and NRS during catheterization were significant predictive factors for PHN at 6 months. The incidence of PHN is higher in zoster patients with severe pain that requires continuous epidural block compared to incidence in the general population. Advanced age and severe initial pain intensity were predictive factors of PHN development. Prolonged catheterization resulting from weak response to treatment strongly suggested progression to PHN. PMID:27512887

  10. Infectious Mononucleosis

    PubMed Central

    Dunmire, Samantha K.; Hogquist, Kristin A.; Balfour, Henry H.

    2015-01-01

    Infectious mononucleosis is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue and fever most often seen in adolescents and young adults and lasting several weeks. It can be caused by a number of pathogens, but this chapter only discusses infectious mononucleosis due to primary Epstein-Barr virus (EBV) infection. EBV is a γ-herpesvirus that infects at least 90% of the population worldwide. The virus is spread by intimate oral contact among teenagers and young adults. How preadolescents acquire the virus is not known. A typical clinical picture with a positive heterophile test is usually sufficient to make the diagnosis, but heterophile antibodies are not specific and do not develop in some patients. EBV-specific antibody profiles are the best choice for staging EBV infection. In addition to causing acute illness, there can also be long-term consequences as the result of acquisition of the virus. Several EBV related illnesses occur including certain cancers and autoimmune diseases, as well as complications of primary immunodeficiency in persons with the certain genetic mutations. A major obstacle to understanding these sequelae has been the lack of an efficient animal model for EBV infection, although progress in primate and mouse models has recently been made. Key future challenges are to develop protective vaccines and effective treatment regimens. PMID:26424648

  11. Preparing to introduce the varicella vaccine into the Italian immunisation programme: varicella-related hospitalisations in Tuscany, 2004-2012.

    PubMed

    Boccalini, Sara; Bonanni, Paolo; Bechini, Angela

    2016-06-16

    A universal immunisation programme against varicella in the form of the measles-mumps-rubella-varicella (MMRV) vaccine for toddlers aged 13-15 months was introduced in Tuscany in July 2008. An assessment of the impact of this programme on varicella-related hospitalisations 4 years after its introduction could further support its adoption at a national level. The hospitalisation data were analysed in two periods: pre-vaccination (2004-2007) and vaccination period (2009-2012). The high coverage of the vaccines (84% in 2012) resulted in a significant decline in notifications, from 33,114 (2004-2007) to 13,184 cases (2009-2012), and also of hospitalisations, from 584 (pre-vaccination period) to 325 (vaccination period). The hospitalisation rate was 4.1 per 100,000 (95% confidence intervals (CI): 3.4-4.7) before the introduction of vaccination, which dropped to 2.2 per 100,000 (95% CI: 1.7-2.7) in the vaccination period (hospitalisation risk ratios: 0.54; 95% CI:  0.472-0.619). The reduction was most significant in the youngest age groups. The introduction of universal vaccination has already led to a significant decline in hospitalisations due to varicella after just 4 years of implementation. Hospitalisation rates fell noticeably among younger individuals involved in the vaccination programme. The decrease in hospitalisation rate in the older age groups suggests a possible indirect protection. PMID:27336188

  12. The Impact of Pharmacist Interventions on Herpes Zoster Vaccination Rates.

    PubMed

    Eid, Deeb D; Meagher, Rebecca C; Lengel, Aaron J

    2015-08-01

    The Centers for Disease Control and Prevention found that in 2010 only 14.4% of people in the United States who are appropriate candidates received the herpes zoster (shingles) vaccine. This manuscript highlights recent studies that investigate how pharmacists can help improve vaccination rates of herpes zoster in the geriatric population. Research has demonstrated that face-to-face interaction, education, and outreach by pharmacists in the community can help improve rates of herpes zoster vaccination. Having pharmacists take time to talk with patients about the vaccine was shown to have a positive impact on vaccine rates. When face-to-face interactions are not feasible, promotional materials such as newspaper advertisements, flyers, and personalized letters were also found to have a beneficial impact. Pharmacists should consider ways to increase awareness of vaccinations and directly encourage their patients to be vaccinated. PMID:26260642

  13. HIV prevalence in patients with herpes zoster.

    PubMed

    Kar, P K; Ramasastry, C V

    2003-01-01

    To monitor HIV seroprevalence and to determine the sexual risk behaviour of men with herpes zoster (HZ), a study was conducted from Jan 98 to Dec 99 among 115 men of 21 to 55 years of age suffering from HZ. The diagnosis of HZ was clinical and relevant investigations when indicated were carried out to exclude immunodeficiency state. None of the cases were on immunosuppressive drugs. All cases were tested for HIV by immunocomb method and if found positive were confirmed by Western blot assay. Out of 115 cases of HZ 11 (9.5%) were found to be HIV positive. 11 (10.8%) of HIV positive cases were 21-40 years of age. More than one dermatome was involved in 7 (63.6%) HIV positive and in 2 (1.9%) HIV negative cases. 2 HIV positive cases had multiple cranial nerve involvement and one had generalized HZ. None of the cases showed evidence of progression to symptomatic HIV disease. Out of 11 HIV positive cases 9 (81.8%) gave history of multiple unprotected sexual exposures with female commercial sex workers and 2 (18.1%) with amateurs. None of our cases had used condom during sexual intercourse. None gave history of blood transfusion in the past or intravenous drug use. PMID:17642851

  14. Purpuric herpes zoster in patients in therapy with clopidogrel.

    PubMed

    Veraldi, S; Vaira, F; Nazzaro, G

    2015-08-01

    Clopidogrel is an adenosine diphosphate receptor antagonist used for the prevention of vascular events in patients with atherothrombotic diseases manifested by recent myocardial infarction, ischemic stroke or peripheral arterial disease. Diarrhoea, rash and pruritus are rather common side effects of clopidogrel. Other side effects include epistaxis, nausea, abdominal pain, vomiting, gastritis, gastric and duodenal ulcer. Thrombocytopenia is the most common laboratory abnormality. Leucopenia and neutropenia are rare. We report three cases of purpuric herpes zoster in patients in therapy with clopidogrel. To our knowledge, only one case of haemorrhagic herpes zoster has been published in a patient in therapy with this drug. PMID:26209393

  15. Herpes zoster-associated acute urinary retention in immunocompetent patient.

    PubMed

    Marques, Silvio Alencar; Hortense, Juliana

    2014-01-01

    Herpes zoster-associated urinary retention is an uncommon event related to virus infection of the S2-S4 dermatome. The possible major reasons are ipsilateral hemicystitis, neuritis-induced or myelitis-associated virus infection. We report a case of a 65-year-old immunocompetent female patient who presented an acute urinary retention after four days under treatment with valacyclovir for gluteal herpes zoster. The patient had to use a vesical catheter, was treated with antibiotics and corticosteroids and fully recovered after eight weeks. PMID:25387508

  16. Attitude toward immunization and risk perception of measles, rubella, mumps, varicella, and pertussis in health care workers working in 6 hospitals of Florence, Italy 2011

    PubMed Central

    Taddei, Cristina; Ceccherini, Vega; Niccolai, Giuditta; Porchia, Barbara Rita; Boccalini, Sara; Levi, Miriam; Tiscione, Emilia; Santini, Maria Grazia; Baretti, Simonetta; Bonanni, Paolo; Bechini, Angela

    2014-01-01

    Background: Health care workers (HCWs) are at risk of infection and transmission of vaccine-preventable infectious diseases. In recent years cases of measles or varicella in health care workers were observed with increasing frequency. The aim of our study was to investigate attitude toward immunization and risk perception of measles, rubella, mumps, varicella, and pertussis in HCWs working in 6 hospitals of Florence (Italy). Methods: A cross-sectional survey among the physicians, nurses, midwives, and nursing assistants working in selected departments was performed trough a self-administered, anonymous questionnaire. Overall, 600 questionnaires were sent and 436 HCWs’ completed forms were included into the study (Participation rate: 72.7%). Data were analyzed with STATA 11.0® and odds ratio (OR) were calculated in a multivariate analysis. Results: Among all respondents 74.9% were females. The average age was nearly 43-years-old (42.9 – SD 8.95). The majority of participants (58.6%) were nurses, 21.3% physicians, 12.9% nursing assistants, and 7.2% were midwives. Among those HCWs reporting no history of disease, 52.8% (95% CI: 42.0–63.3%) declared to have been immunized for measles, 46.9% for rubella (95% CI: 39.0–54.9%), 21.6% for mumps (95% CI: 15.1–29.4%), 14.9% for varicella (95% CI: 7.4–25.7%), and 14.5% for pertussis (95% CI: 10.0–20.0%). When considering potentially susceptible HCWs (without history of disease or vaccination and without serological confirmation), less than a half of them feel at risk for the concerned diseases and only less than 30% would undergo immunization. One of the main reasons of the relatively low coverage was indeed lack of active offer of vaccines. Conclusion: Attitudes toward immunization observed in this study are generally positive for preventing some infectious diseases (i.e., measles and rubella), but relatively poor for others (i.e., varicella). More information should be made available to HCWs on the benefits of

  17. Increasing Trends of Herpes Zoster in Australia

    PubMed Central

    MacIntyre, Raina; Stein, Alicia; Harrison, Christopher; Britt, Helena; Mahimbo, Abela; Cunningham, Anthony

    2015-01-01

    Background Increasing trends in incidence of herpes zoster (HZ) have been reported in Australia and internationally. This may reflect the impact of childhood VZV vaccination programs introduced universally in Australia in late 2005. The objective of this study was to evaluate changes in incidence of HZ and PHN in Australia over time, and associated healthcare resource utilisation. Methods Australian data on general practice (GP) encounters for HZ, specific antiviral prescribing data from the pharmaceutical benefits scheme, emergency department presentations from the states of NSW and Victoria and national hospitalisation data for HZ were analysed for time trends using regression models. Two time periods (2000-2006 and 2006-2013) were compared which correspond broadly with the pre- and post- universal VZV vaccination period. Results All data sources showed increasing rates of HZ with age and over time. The GP database showed a significant annual increase in encounters for HZ of 2.5 per 100,000 between 1998 and 2013, and the rates of prescriptions for HZ increased by 4.2% per year between 2002 and 2012. In the 60+ population HZ incidence was estimated to increase from 11.9 to 15.4 per 1,000 persons using GP data or from 12.8 to 14.2 per 1,000 persons using prescription data (p<0.05, between the two periods). Hospitalisation data did not show the same increasing trend over time, except for the age group ≥80 years. Most emergency visits for HZ were not admitted, and showed significant increases over time. Discussion The burden of HZ in Australia is substantial, and continues to increase over time. This increase is seen both pre- and post-universal VZV vaccination in 2005, and is most prominent in the older population. The substantial burden of HZ, along with ageing of the Australian population and the importance of healthy ageing, warrants consideration of HZ vaccination for the elderly. PMID:25928713

  18. Skin infections in pregnancy.

    PubMed

    Müllegger, Robert R; Häring, Nina S; Glatz, Martin

    2016-01-01

    A wide array of infectious diseases can occur in pregnancy. Their acquisition, clinical presentation, and course during gestation may be altered due to an impairment of the maternal cellular immunity. Some infectious diseases can lead to serious consequences for the mother or the offspring, including congenital malformations. This review describes in detail the clinical presentation, course, management, and associated maternal and fetal risks of selected viral (varicella-zoster virus infections, condylomata acuminata), fungal (candida vulvovaginitis), bacterial (Lyme borreliosis), and parasitic (scabies) infections. The treatment options are critically reviewed. First-line therapies include acyclovir and varicella-zoster virus immunoglobulin for varicella-zoster virus infections, surgical modalities for genital warts, topical clotrimazole and oral fluconazole for Candida vulvovaginitis, amoxicillin and cefuroxime for Lyme borreliosis, and permethrin for scabies. A synopsis of maternal and fetal risks of other important infections is also included. PMID:27265075

  19. Bilateral disseminated herpes zoster in an immunocompetent host.

    PubMed

    Takaoka, Yumiko; Miyachi, Yoshiki; Yoshikawa, Yoshiaki; Tanioka, Miki; Fujisawa, Akihiro; Endo, Yuichiro

    2013-02-01

    Herein we report a rare case of disseminated herpes zoster(HZ) infection involving two widely separated bilateral dermatomes in an immunocompetent host. HZ involving two widely separated areas simultaneously is referred to as HZ duplex bilateralis. It is very rare, with an incidence of less than 0.1 percent of all HZ cases, and usually develops in immunocompromised patients. PMID:23473283

  20. Varicella Vaccine Effectiveness in Preventing Community Transmission in the 2-Dose Era

    PubMed Central

    Perella, Dana; Wang, Chengbin; Civen, Rachel; Viner, Kendra; Kuguru, Karen; Daskalaki, Irini; Schmid, D. Scott; Lopez, Adriana S.; Tseng, Hung Fu; Newbern, E. Claire; Mascola, Laurene; Bialek, Stephanie R.

    2016-01-01

    Objectives We examined overall and incremental effectiveness of 2-dose varicella vaccination in preventing community transmission of varicella among children aged 4–18 years in two active surveillance sites. One-dose varicella vaccine effectiveness (VE) was examined in those aged 1–18 years. Methods From May 2009 through June 2011, varicella cases identified during active surveillance in Antelope Valley, CA and Philadelphia, PA were enrolled into a matched case-control study. Matched controls ±2 years of the incident case's age were selected from immunization registries. A standardized questionnaire was administered to participants' parents, and varicella vaccination history was obtained from healthcare provider, immunization registry, or parent records. We used conditional logistic regression to estimate varicella VE against clinically-diagnosed and laboratory-confirmed varicella. Results One hundred twenty-five clinically-diagnosed varicella cases and 408 matched controls were enrolled. Twenty-nine cases were laboratory-confirmed. One-dose VE (1-dose vs. unvaccinated) was 75.6% [95% confidence interval (CI): 38.7–90.3%] in preventing any clinically-diagnosed varicella and 78.1% (95% CI: 12.7–94.5%) against moderate/severe, clinically-diagnosed disease (≥50 lesions). Among subjects aged ≥4 years, 2-dose VE (2-dose vs. unvaccinated) was 93.6% (95% CI: 75.6–98.3%) against any varicella and 97.9% (95% CI: 83.0–99.7%) against moderate/severe varicella. Incremental effectiveness (2-dose vs. 1-dose) was 87.5% against clinically-diagnosed varicella and 97.3% against laboratory-confirmed varicella. Compared with 1-dose breakthrough cases, 2-dose cases had shorter duration of rash (P=0.01) and were 80% less likely to develop vesicular rashes (P=0.01). Conclusions Two-dose varicella vaccination offered improved protection against varicella from community transmission among school-aged children compared with 1-dose vaccination. PMID:26977081

  1. Varicella vaccination coverage of children under two years of age in Germany

    PubMed Central

    2010-01-01

    Background Since July 2004, routine varicella vaccination is recommended by the German Standing Vaccination Committee in Germany. Health Insurance Funds started to cover vaccination costs at different time points between 2004 and 2006 in the Federal States. Nationwide representative data on vaccination coverage against varicella of children under two years of age are not available. We aimed to determine varicella vaccination coverage in statutory health insured children under two years of age in twelve German Federal States using data from associations of statutory health insurance physicians (ASHIPs), in order to investigate the acceptance of the recommended routine varicella vaccination programme. Methods We analysed data on varicella vaccination from 13 of 17 ASHIPs of the years 2004 to 2007. The study population consisted of all statutory health insured children under two years of age born in 2004 (cohort 2004) or 2005 (cohort 2005) in one of the studied regions. Vaccination coverage was determined by the number of children vaccinated under 2 years of age within the study population. Results Varicella vaccination coverage of children under two years of age with either one dose of the monovalent varicella vaccine or two doses of the measles, mumps, rubella, and varicella vaccine increased from 34% (cohort 2004) to 51% (cohort 2005) in the studied regions (p < 0.001). More than half of the vaccinated children of cohort 2004 and two third of cohort 2005 were immunised at the recommended age 11 to 14 months. The level of vaccination coverage of cohort 2004 was significantly associated with the delay in introduction of cost coverage since the recommendation of varicella vaccination (p < 0.001). Conclusions Our study shows increasing varicella vaccination coverage of young children, indicating a growing acceptance of the routine varicella vaccination programme by the parents and physicians. We recommend further monitoring of vaccination coverage using data from

  2. Safety and Immunogenicity of an Adjuvanted Herpes Zoster Subunit Candidate Vaccine in HIV-Infected Adults: A Phase 1/2a Randomized, Placebo-Controlled Study

    PubMed Central

    Berkowitz, Elchonon M.; Moyle, Graeme; Stellbrink, Hans-Jürgen; Schürmann, Dirk; Kegg, Stephen; Stoll, Matthias; El Idrissi, Mohamed; Oostvogels, Lidia; Heineman, Thomas C.; Brockmeyer, Norbert; deJesus, Edwin; Esser, Stefan; Hawkins, Trevor; Lalezari, Jacob; Orkin, Chloe; Schneider, Stefan

    2015-01-01

    Background. Human immunodeficiency virus (HIV)–infected individuals are at increased risk of herpes zoster (HZ), even in the antiretroviral therapy (ART) era. Because concerns exist about the use of live-attenuated vaccines in immunocompromised individuals, a subunit vaccine may be an appropriate alternative. Methods. This phase 1/2, randomized, placebo-controlled study evaluated the immunogenicity and safety of an investigational HZ subunit vaccine (HZ/su). Three cohorts of HIV-infected adults aged ≥18 years were enrolled: 94 ART recipients with a CD4+ T-cell count of ≥200 cells/mm3, 14 ART recipients with a CD4+ T-cell count of 50–199 cells/mm3, and 15 ART-naive adults with a CD4+ T-cell count of ≥500 cells/mm3. Subjects received 3 doses of HZ/su (50 µg varicella-zoster virus glycoprotein E [gE] combined with AS01B adjuvant) or 3 doses of saline at months 0, 2, and 6. Results. One month after dose 3, serum anti-gE antibody concentrations and frequencies of gE-specific CD4+ T cells were higher following HZ/su vaccination than after receipt of saline (P < .0001). Median cell-mediated immune responses peaked after dose 2. Humoral and cell-mediated immune responses persisted until the end of the study (month 18). No vaccination-related serious adverse events were reported. No sustained impact on HIV load or CD4+ T-cell count was noted following vaccinations. Conclusions. HZ/su was immunogenic and had a clinically acceptable safety profile in HIV-infected adults. Clinical Trials Registration. NCT01165203. PMID:25371534

  3. Incidences of Herpes Zoster and Postherpetic Neuralgia in Japanese Adults Aged 50 Years and Older From a Community-based Prospective Cohort Study: The SHEZ Study

    PubMed Central

    Takao, Yukiko; Miyazaki, Yoshiyuki; Okeda, Masayuki; Onishi, Fumitake; Yano, Shuichiro; Gomi, Yasuyuki; Ishikawa, Toyokazu; Okuno, Yoshinobu; Mori, Yasuko; Asada, Hideo; Yamanishi, Koichi; Iso, Hiroyasu

    2015-01-01

    Background Many cross-sectional studies have examined the incidences of herpes zoster (HZ) and postherpetic neuralgia (PHN), but prospective studies in Japanese older adults are lacking. Therefore, we conducted a community-based prospective cohort study to determine the incidence in Japanese adults aged ≥50 years. Methods We recruited 12 522 participants from Shozu County, Kagawa Prefecture, between December 2008 and November 2009 and followed participants for 3 years. When a subject presented with symptoms suggestive of HZ, they were examined at collaborating medical institutions and cooperated with onset and recovery surveys (eg, measurement of varicella zoster virus-specific immunity and a pain survey). The hazard ratios (HRs) of HZ and PHN according to sex and age were analyzed by Cox regression analysis with a significance level of 5%. Results The incidence of HZ was 10.9/1000 person-years (men: 8.5/1000 person-years; women: 12.8/1000 person-years) and was significantly higher in women than in men (HR 1.5; 95% confidence interval, 1.2–1.8). The incidence of PHN was 2.1/1000 person-years (men: 1.7/1000 person-years; women: 2.4/1000 person-years), with no significant sex differences. A total of 19% of HZ cases progressed to PHN; no sex-specific difference in the proportion of PHN cases was observed. Conclusions We clarified the accurate incidences of HZ and PHN in a population of Japanese older adults. These incidences increased with age. HZ incidence was higher in women than in men, while PHN incidence did not differ markedly between the sexes. PMID:26399445

  4. Incidence of herpes zoster infections in juvenile idiopathic arthritis patients.

    PubMed

    Nimmrich, S; Horneff, G

    2015-03-01

    The risk of herpes zoster among patients with juvenile idiopathic arthritis (JIA) exposed to biologics has not been evaluated. We determined incidence rates of herpes zoster among children with JIA in correlation with medication at time of occurrence and total drug exposure. The German biologics register database was used to identify patients with herpes zoster. Crude infection rates and incidence ratios (IRR) were compared to published rates. Demographics and overall exposure and particular exposure time to corticosteroids, immunosuppressive drugs and biologics were analyzed. The JIA cohort included 3,042 patients with 5,557.9 person-years of follow-up; 1,628 have used corticosteroids, 2,930 methotrexate and 1,685 etanercept. In total, 17 herpes zoster events have been documented [6/1,000 patients (3.5-9.0); 3.1/1,000 patient-years (1.9-4.9)]. Thus, the incidence rate in JIA patients was higher than expected [IRR 2.9 (1.8-4.5), p < 0.001]. In all patients, the event resolved completely. There were two complications, one patient developed intercostal neuralgia, and one had a recurrent herpes zoster. Compared to the healthy population, a significant higher IRR is observed in JIA patients who received a monotherapy with etanercept or in combination with steroids and methotrexate, but not in JIA patients exposed to methotrexate without biologics. In comparison with our control group of patients treated with methotrexate, the IRR was higher for exposure to etanercept monotherapy and combination of etanercept and corticosteroids irrespective of methotrexate use. A generally higher incidence rate in JIA patients treated with etanercept was observed. No serious or refractory manifestations occurred. PMID:25583050

  5. Zoster paresis: asymptomatic MRI lesions far beyond the site of rash and focal weakness.

    PubMed

    Tsai, Jean; Bert, Robert J; Gilden, Don

    2013-07-15

    We describe a patient with zoster paresis and an MRI that revealed extensive spinal cord lesions from the upper cervical to the lower thoracic spinal cord. Importantly, the patient reported considerable spontaneous improvement in strength 2-3 weeks after zoster. This report reveals a previously undescribed remarkable preponderance of MRI lesions far beyond the site of zoster rash and focal lower motor neuron weakness. PMID:23628467

  6. Successful rescue of disseminated varicella infection with multiple organ failure in a pediatric living donor liver transplant recipient: a case report and literature review.

    PubMed

    Yamada, Naoya; Sanada, Yukihiro; Okada, Noriki; Wakiya, Taiichi; Ihara, Yoshiyuki; Urahashi, Taizen; Mizuta, Koichi

    2015-01-01

    A 12-year-old female patient with biliary atresia underwent living donor liver transplantation (LDLT). Twelve months after the LDLT, she developed acute hepatitis (alanine aminotransferase 584 IU/L) and was diagnosed with disseminated varicella-zoster virus (VZV) infection with high level of serum VZV-DNA (1.5 × 10(5) copies/mL) and generalized vesicular rash. She had received the VZV vaccination when she was 5-years-old and had not been exposed to chicken pox before the LDLT, and her serum was positive for VZV immunoglobulin G at the time of the LDLT. Although she underwent treatment with intravenous acyclovir, intravenous immunoglobulin, and withdrawal of immunosuppressants, her symptoms worsened and were accompanied by disseminated intravascular coagulation, pneumonia, and encephalitis. These complications required treatment in the intensive care unit for 16 days. Five weeks later, her clinical findings improved, although her VZV-DNA levels remained high (8.5 × 10(3)copies/mL). Oral acyclovir was added for 2 weeks, and she was eventually discharged from our hospital on day 86 after admission; she has not experienced a recurrence. In conclusion, although disseminated VZV infection with multiple organ failure after pediatric LDLT is a life-threatening disease, it can be cured via an early diagnosis and intensive treatment. PMID:26081644

  7. Combination Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children

    PubMed Central

    Ma, Shu-Juan; Li, Xing; Xiong, Yi-Quan; Yao, A.-.ling; Chen, Qing

    2015-01-01

    Abstract A combined measles-mumps-rubella-varicella (MMRV) vaccine is expected to facilitate universal immunization against these 4 diseases. This study was undertaken to synthesize current research findings of the immunogenicity and safety of MMRV in healthy children. We searched PubMed, Embase, BIOSIS Previews, Web of Science, Cochrane Library, and other databases through September 9, 2014. Eligible randomized controlled trials (RCTs) were selected and collected independently by 2 reviewers. Meta-analysis was conducted using Stata 12.0 and RevMan 5.3. Twenty-four RCTs were included in qualitative synthesis. Nineteen RCTs compared single MMRV dose with measles-mumps-rubella vaccine with or without varicella vaccine (MMR + V/MMR). Similar seroconversion rates of these 4 viruses were found between comparison groups. There were comparable geometric mean titers (GMTs) against mumps and varicella viruses between MMRV group and MMR + V/MMR group. MMRV group achieved enhanced immune response to measles component, with GMT ratio of 1.66 (95% confidence interval [CI] 1.48, 1.86; P < 0.001) for MMRV versus MMR and 1.62 (95% CI 1.51, 1.70; P < 0.001) for MMRV versus MMR + V. Meanwhile, immune response to rubella component in MMRV group was slightly reduced, GMT ratios were 0.81 (95% CI 0.78, 0.85; P < 0.001) and 0.79 (95% CI 0.76, 0.83; P < 0.001), respectively. Well tolerated safety profiles were demonstrated except higher incidence of fever (relative risks 1.12–1.60) and measles/rubella-like rash (relative risks 1.44–1.45) in MMRV groups. MMRV had comparable immunogenicity and overall safety profiles to MMR + V/MMR in healthy children based on current evidence. PMID:26554769

  8. Orbital Apex Syndrome Secondary to Herpes Zoster Ophthalmicus.

    PubMed

    Verhaeghe, Florent; Villain, Max; Labauge, Pierre; Daien, Vincent

    2016-06-01

    Orbital apex syndrome is a rare complication of herpes zoster ophthalmicus. In addition to our case, we review the clinical presentation, imaging findings, treatment options, and prognosis of 14 other reported cases. Magnetic resonance imaging of our patient demonstrated diffuse enhancement of the orbit involving the orbital apex, optic nerve and/or nerve sheath, extraocular muscles, and orbital soft tissues. There was significant clinical improvement with acyclovir and systemic corticosteroids, which seems to be preferred treatment for this disorder. PMID:26928600

  9. Disseminated herpes zoster infection initially presenting with abdominal pain in patients with lymphoma undergoing conventional chemotherapy: A report of three cases

    PubMed Central

    Okuma, Hitomi Sumiyoshi; Kobayashi, Yukio; Makita, Shinichi; Kitahara, Hideaki; Fukuhara, Suguru; Munakata, Wataru; Suzuki, Tatsuya; Maruyama, Dai; Tobinai, Kensei

    2016-01-01

    Visceral disseminated varicella zoster virus (VZV) disease has a high mortality rate, and occurs in immunocompromised hosts, mostly subsequent to allogeneic stem cell transplantation. Only a few cases of this disease that onset during conventional chemotherapy in patients with lymphoma have been reported. The present study reports the cases of 3 patients with disseminated and visceral VZV infection undergoing treatment for follicular lymphoma, diffuse large B-cell lymphoma and peripheral T-cell lymphoma, not otherwise specified. All 3 patients presented with initial symptoms of abdominal pain, and 2 patients demonstrated syndrome of inappropriate antidiuretic hormone and hepatitis. All patients developed widespread cutaneous dissemination, and all had a low cluster of differentiation 4 cell count or lymphocyte count at the time of VZV diagnosis and at least 4 month prior. With intravenous systemic acyclovir therapy (Cases 1 and 3, 1500 mg/day; Case 2, 750 mg/day), the patients achieved complete recovery by day 14 of therapy. Visceral disseminated VZV infection is not limited to patients undergoing stem cell transplantation, and may present with abdominal pain with or without skin eruption. Visceral infection may take a poor clinical course, therefore, in patients with prolonged duration of low lymphocyte count and/or long-term use of steroids, the prophylactic use of acyclovir may be considered. PMID:27446355

  10. Varicella in Europe-A review of the epidemiology and experience with vaccination.

    PubMed

    Helmuth, Ida Glode; Poulsen, Anja; Suppli, Camilla Hiul; Mølbak, Kåre

    2015-05-15

    There is no consensus as regards the European varicella immunisation policy; some countries have introduced varicella vaccination in their routine childhood immunisation programs whereas others have decided against or are debating. With the aim of providing an overview of the epidemiology of varicella in Europe and addressing the different strategies and the experiences so far, we performed a review of epidemiological studies done in Europe from 2004 to 2014. Varicella is mainly a disease of childhood, but sero-epidemiological studies show regional differences in the proportion of susceptible adults. Hospitalisation due to varicella is not common, but complications and hospitalisation mainly affect previously healthy children, which underlines the importance of not dismissing varicella as a disease of little importance. The experience with universal vaccination in Europe shows that vaccination leads to a rapid reduction of disease incidence. Vaccine effectiveness is high and a protective herd effect is obtained. Experience with vaccination in Europe has not been long enough, though, to draw conclusions on benefits and drawbacks with vaccination as well as the capacity for national programs in Europe to maintain a sufficiently high coverage to prevent a change in age group distribution to older children and young adults or on the impact that varicella immunisation may have on the epidemiology of shingles. PMID:25839105

  11. Varicella encephalitis and pneumonia in a patient with end stage renal failure

    PubMed Central

    2014-01-01

    We describe a patient with end stage renal failure (ESRF) on hemodialysis who was admitted to our department for primary varicella infection complicated by varicella pneumonia and encephalitis. Varicella infections results in serious morbidity and mortality in ESRF dialysis and transplant patients. Evidence published thus far suggests that live attenuated varicella vaccines are effective and safe in ESRF and renal transplant patients. Worldwide a few countries have instituted guidelines for the varicella immunisation in ESRF patients. However, in the Asia Pacific Region, it has not been widely given due to the lack of national consensus guidelines. Our case depicts that primary varicella infection can occur at any time in immunosupressed patients and thus suffer serious consequences from it. With increasing burden of chronic kidney disease, Renal Physicians and Family Physicians in the Asia Pacific Region should meet and study the epidemiological data in each individual country and decide on the consensus guidelines on how the varicella vaccination can be targeted for those at risk. PMID:24555522

  12. The association between varicella (chickenpox) and group A streptococcus infections in historical perspective

    PubMed Central

    Coleman, Stephen

    2016-01-01

    Objectives: The aim of the research is to investigate the historical relationship between varicella and Streptococcus pyogenes infections. In the past few decades, varicella has been identified as a risk factor for invasive group A streptococcus infections. The question is whether this relationship also existed between varicella and scarlet fever in the historical era. Methods: The analysis begins with a search of historical medical reports on the relationship between varicella and scarlet fever epidemics in the late 19th and early 20th century, as well as in more recent empirical studies. Correlations and cross-correlations between varicella and scarlet fever are analyzed using weekly public health case reports from 1924 to 1932 for Boston, Chicago, New York City, and Philadelphia. Regression models are used to estimate the relationship between varicella and scarlet fever after controlling for seasonal forcing. Results: Historical records give limited support for a causal relationship between varicella and scarlet fever but indicate that these diseases often occurred close in time to each other. Likewise, statistical analysis shows that varicella and scarlet fever epidemics are closely aligned with each other, and varicella has a strong relationship with scarlet fever. The relationship is stronger than reported in any previous research on the two diseases. Conclusion: The close correspondence of the two diseases likely depends on multiple factors, including seasonal forcing, a causal relationship, and co-infections. The results raise questions about whether this close relationship might have had a synergistic effect or a role in the evolution of S. pyogenes from the virulent, high incidence epidemics of the 19th century to the relatively benign scarlet fever of the 1950s. PMID:27504182

  13. Varicella Disease in Beijing in the Era of Voluntary Vaccination, 2007 to 2010

    PubMed Central

    Lu, Li; Wang, Chengbin; Suo, Luodan; Li, Juan; Liu, Weixiang; Pang, Xinghuo; Seward, Jane F.

    2015-01-01

    Background In China, varicella vaccine has been available in the private sector to children ≥12 months of age since 1998 with a single-dose indication. In December 2006, varicella became a notifiable disease in Beijing. We used surveillance data to describe varicella vaccine uptake from 2005 to 2010 and varicella epidemiology in Beijing from 2007 to 2010. Methods Limited sociodemographic and clinical information was available from the passive surveillance system. Varicella vaccine coverage was estimated for each year for children born between 2004 and 2008 using the number of children in the immunization registry of each birth year as the denominator without adjustment for history of varicella. Results Vaccine coverage increased within each birth cohort between 2005 and 2010. The coverage at 2 years of age increased from 62.4% in 2005 to 74.1% in 2010 and was 80.4% in children 3–6 years of age in 2010. Between 2007 and 2010, 15,544 to 18,256 varicella cases were reported annually with stable overall incidence (range: 1.0–1.1/1000 persons), but the incidence in children 1–4 years of age decreased significantly from 6.2 per 1000 children in 2007 to 4.4 per 1000 children in 2010 (P < 0.001). Among adults (≥20 years of age), there were significant increases in the number and proportion of cases from 2557 (16.5%) in 2007 to 4277 (23.4%) in 2010 (P < 0.001). Conclusions Moderately high 1-dose vaccine coverage in young children has been achieved with declining disease incidence, but varicella remains a common, seasonal disease in the population. Current epidemiology suggests that a government-funded varicella vaccine program that includes catch-up vaccination for older children, adolescents and adults needs consideration. PMID:23429564

  14. Spontaneous Tooth Exfoliation after Trigeminal Herpes Zoster: A Case Series of an Uncommon Complication

    PubMed Central

    Mahajan, Vikram K; Ranjan, Nitin; Sharma, Sangeet; Sharma, Nand Lal

    2013-01-01

    The most significant and debilitating complication of herpes zoster (HZ) is herpetic neuralgia that accompanies and may persist in 10-15% of all zoster patients, particularly those over 60 years of age. The described 3 cases had an uncommon complication of spontaneous tooth exfoliation after trigeminal HZ that rarely finds mention in dermatology literature. PMID:23723511

  15. Varicella Skin Complications in Childhood: A Case Series and a Systematic Review of the Literature

    PubMed Central

    Bozzola, Elena; Bozzola, Mauro; Krzysztofiak, Andrzej; Tozzi, Alberto Eugenio; El Hachem, May; Villani, Alberto

    2016-01-01

    Even if varicella is generally considered a harmless disease in childhood, severe complications may occur. We examined varicella skin complications (VSCs) in hospitalized immunologically healthy children, over a nine-year period. We also systematically analyzed previous reports to calculate the rate of VSCs in the literature. VSCs occurred in 16.4% of children hospitalized for varicella. This figure is in accordance with the literature, as the range of VSCs was 2.6%–41.2%. Skin complications may represent determinants of hospitalization and of other indirect costs in young children. PMID:27164095

  16. Varicella Skin Complications in Childhood: A Case Series and a Systematic Review of the Literature.

    PubMed

    Bozzola, Elena; Bozzola, Mauro; Krzysztofiak, Andrzej; Tozzi, Alberto Eugenio; El Hachem, May; Villani, Alberto

    2016-01-01

    Even if varicella is generally considered a harmless disease in childhood, severe complications may occur. We examined varicella skin complications (VSCs) in hospitalized immunologically healthy children, over a nine-year period. We also systematically analyzed previous reports to calculate the rate of VSCs in the literature. VSCs occurred in 16.4% of children hospitalized for varicella. This figure is in accordance with the literature, as the range of VSCs was 2.6%-41.2%. Skin complications may represent determinants of hospitalization and of other indirect costs in young children. PMID:27164095

  17. Challenges with controlling varicella in prison settings: Experience of California, 2010–2011

    PubMed Central

    Leung, Jessica; Lopez, Adriana S.; Tootell, Elena; Baumrind, Nikki; Mohle-Boetani, Janet; Leistikow, Bruce; Harriman, Kathleen H.; Preas, Christopher P.; Cosentino, Giorgio; Bialek, Stephanie R.; Marin, Mona

    2015-01-01

    We describe the epidemiology of varicella in one state prison in California during 2010–2011, control measures implemented, and associated costs. Eleven varicella cases were reported, 9 associated with 2 outbreaks. One outbreak consisted of 3 cases and the second consisted of 6 cases with 2 generations of spread. Among exposed inmates serologically tested, 98% (643/656) were VZV sero-positive. The outbreaks resulted in >1,000 inmates exposed, 444 staff exposures, and >$160,000 in costs. We documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary for managing cases and outbreaks. PMID:25201912

  18. MMRV (Measles, Mumps, Rubella, and Varicella) Vaccine: What You Need to Know

    MedlinePlus

    ... STATEMENT MMRV Vaccine What You Need to Know (Measles, Mumps, Rubella and Varicella) Many Vaccine Information Statements ... and V aricella (chickenpox) can be serious diseases: Measles • Causes rash, cough, runny nose, eye irritation, fever. • ...

  19. Space-time airborne disease mapping applied to detect specific behaviour of varicella in Valencia, Spain.

    PubMed

    Iftimi, Adina; Montes, Francisco; Santiyán, Ana Míguez; Martínez-Ruiz, Francisco

    2015-01-01

    Airborne diseases are one of humanity's most feared sicknesses and have regularly caused concern among specialists. Varicella is an airborne disease which usually affects children before the age of 10. Because of its nature, varicella gives rise to interesting spatial, temporal and spatio-temporal patterns. This paper studies spatio-temporal exploratory analysis tools to detect specific behaviour of varicella in the city of Valencia, Spain, from 2008 to 2013. These methods have shown a significant association between the spatial and the temporal component, confirmed by the space-time models applied to the data. High relative risk of varicella is observed in economically disadvantaged regions, areas less involved in vaccination programmes. PMID:26530821

  20. Early diagnosis of post-varicella necrotising fasciitis: A medical and surgical emergency

    PubMed Central

    Xavier, Rose; Abraham, Bobby; Cherian, Vinod Jacob; Joseph, Jobin I.

    2016-01-01

    Necrotising fasciitis (NF) is an extremely rare complication of a rather common paediatric viral exanthem varicella. Delayed diagnosis and treatment can lead to significant morbidity and mortality. Laboratory risk indicator of NF score aids in early clinical diagnosis in suspected cases of post-varicella NF thus enabling timely intervention. Surgery delayed for more than 24 hours, is an independent risk factor for death. Surgical debridement with good antibiotic coverage is the definitive treatment for NF. PMID:27251524

  1. Periorbital varicella gangrenosa: A rare complication of chicken pox.

    PubMed

    Jain, Jagriti; Thatte, Shreya; Singhai, Prakhar

    2015-01-01

    A previously healthy six year old male child presented in pediatrics ICU in state of shock with history of fever and rashes and later was diagnosed as chicken pox. He developed right sided periorbital varicella gangrenosa which is a form of necrotizing fasciitis secondary to skin infection. Patient was treated with intravenous acyclovir, antibiotics, amphotericin B, extensive debridement and later reconstruction of upper eyelid with skin grafting. Aggressive treatment helped preventing the eyeball and orbital involvement which would have necessitated orbital exenteration. However delayed presentation resulted in necrosis of orbicularis oculi and underlying tissue which resulted in graft retraction and lid dysfunction. Clinicians should be aware of this rare but fulminating condition to minimise the sight and life threatening complications associated with it. PMID:25709281

  2. [Herpes zoster and human imunodeficiency virus in the medical centers of Ouagadougou].

    PubMed

    Barro-Traoré, F; Traoré, A; Ilboudo, L; Ouédraogo, L T; Kaboré, J

    2007-01-01

    Herpes zoster is an acute posterior ganglio-radiculitis related to the reactivation of the chicken pox-herpes zoster virus remained quiescent in the neurons of the nerve-knots. It usually occurs at the subject after 60 years old. For young patient, it is closely related to the infection by the HIV. Our exploratory descriptive and analytical study was carried out from 1 October 2002 to 30 September 2003, in order to describe the epidemiological, clinical aspects of the herpes zoster in the medical formations of the town of Ouagadougou (Burkina Faso) and to determine the prevalence of the infection by the HIV in the patients. We have collected 118 patients who have a herpes zoster through 6500 consultants. There were 79 women and 39 men. The average age was 34.4 years. The age bracket from 20 to 40 years was the most touched. The blistered eruption was the first reason for consultation; the light with type of burn, intermittent pain prevailed. The lesions healed in one month but there were 28 ulcerated necrotic cases. Post zoster pains have been observed in 33 cases. The localizations were the members in 44 cases (37.29%), the head in 35 cases (29.66%) and the trunk in 40 cases (33.90%). We have observed a case with double localization of herpes zoster. On 65 patients tested for the HIV, 58 (89.2%) were infected. The age bracket from 20 to 40 was the most concerned. A case of corneal necrosis isolated, with blindness and another with an opposed, spasmodic and total hemi paresis were notified. Fourteen patients having an antecedent of herpes zoster were all infected by HIV. Since the pandemic infection by the HIV, the incidence of the herpes zoster increases within the young population. The high frequency of HIV infection among our patients (89.2%) showed that the herpes zoster is closely related to this disease. PMID:19097409

  3. An overview of infectious complications after allogeneic hematopoietic stem cell transplantation.

    PubMed

    Sahin, Ugur; Toprak, Selami Kocak; Atilla, Pinar Ataca; Atilla, Erden; Demirer, Taner

    2016-08-01

    Infections are the most common and significant cause of mortality and morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The presence of neutropenia and mucosal damage are the leading risk factors in the early pre-engraftment phase. In the early post-engraftment phase, graft versus host disease (GvHD) induced infection risk is increased in addition to catheter related infections. In the late phase, in which reconstitution of cellular and humoral immunity continues, as well as the pathogens seen during the early post-engraftment phase, varicella-zoster virus and encapsulated bacterial infections due to impaired opsonization are observed. An appropriate vaccination schedule following the cessation of immunosuppressive treatment after transplantation, intravenous immunoglobulin administration, and antimicrobial prophylaxis with penicillin or macrolide antibiotics during immunosuppressive treatment for GvHD might decrease the risk of bacterial infections. Older age, severe mucositis due to toxicity of chemotherapy, gastrointestinal tract colonization, prolonged neutropenia, unrelated donor and cord blood originated transplantations, acute and chronic GvHD are among the most indicative clinical risk factors for invasive fungal infections. Mold-active anti-fungal prophylaxis is suggested regardless of the period of transplantation among high risk patients. The novel serological methods, including Aspergillus galactomannan antigen and beta-D-glucan detection and computed tomography are useful in surveillance. Infections due to adenovirus, influenza and respiratory syncytial virus are encountered in all phases after allo-HSCT, including pre-engraftment, early post-engraftment and late phases. Infections due to herpes simplex virus-1 and -2 are mostly seen during the pre-engraftment phase, whereas, infections due to cytomegalovirus and human herpes virus-6 are seen in the early post-engraftment phase and Epstein-Barr virus and varicella-zoster

  4. Erosive Pustular Dermatosis of the Scalp Following Herpes Zoster: Successful Treatment with Topical Tacrolimus

    PubMed Central

    Kim, Kyu Ri; Lee, Ji Yeoun; Kim, Mi Kyeong

    2010-01-01

    Erosive pustular dermatosis of the scalp (EPDS) is a rare disorder of the elderly characterized by multiple pustular lesions with erosions and crusting that result in scarring alopecia. EPDS typically develops in aged or sun-damaged skin with a history of trauma. Histopathologically, EPDS is nonspecific, showing atrophic epidermis and chronic inflammation. Bacteriological and mycological investigations of EPDS are generally negative. Although herpes zoster is a common disorder in elderly people, previously reported cases of EPDS were rarely associated with herpes zoster. We present a rare case of EPDS following herpes zoster treated successfully with topical tacrolimus. PMID:20548924

  5. Herpes Zoster Meningitis Complicating Combined Tocilizumab and Cyclosporine Therapy for Adult-Onset Still's Disease

    PubMed Central

    Tsurukawa, Shinichiro; Iwanaga, Nozomi; Izumi, Yasumori; Shirakawa, Atsunori; Kawahara, Chieko; Shukuwa, Tetsuo; Inamoto, Miwako; Kawakami, Atsushi; Migita, Kiyoshi

    2016-01-01

    A 56-year-old female with refractory adult-onset Still's disease presented with ocular herpes zoster infection during TCZ treatment. After three days of acyclovir treatment (5 mg/kg), she developed a severe headache and high fever. Viral DNA isolation and cerebral spinal fluid abnormalities led to a herpes zoster meningitis diagnosis. Her meningitis was cured by high doses of intravenous acyclovir (10 mg/kg for 14 days). To our knowledge, this is the first report of meningeal herpes zoster infection in rheumatic diseases under TCZ treatment. PMID:27092286

  6. Herpes Zoster Meningitis Complicating Combined Tocilizumab and Cyclosporine Therapy for Adult-Onset Still's Disease.

    PubMed

    Tsurukawa, Shinichiro; Iwanaga, Nozomi; Izumi, Yasumori; Shirakawa, Atsunori; Kawahara, Chieko; Shukuwa, Tetsuo; Inamoto, Miwako; Kawakami, Atsushi; Migita, Kiyoshi

    2016-01-01

    A 56-year-old female with refractory adult-onset Still's disease presented with ocular herpes zoster infection during TCZ treatment. After three days of acyclovir treatment (5 mg/kg), she developed a severe headache and high fever. Viral DNA isolation and cerebral spinal fluid abnormalities led to a herpes zoster meningitis diagnosis. Her meningitis was cured by high doses of intravenous acyclovir (10 mg/kg for 14 days). To our knowledge, this is the first report of meningeal herpes zoster infection in rheumatic diseases under TCZ treatment. PMID:27092286

  7. Overview of Infectious Diseases

    MedlinePlus

    ... Español Text Size Email Print Share Overview of Infectious Diseases Page Content Article Body I nfectious diseases are ... worms Last Updated 11/21/2015 Source Immunizations & Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy ...

  8. [Infectious diseases research].

    PubMed

    Carratalà, Jordi; Alcamí, José; Cordero, Elisa; Miró, José M; Ramos, José Manuel

    2008-12-01

    There has been a significant increase in research activity into infectious diseases in Spain in the last few years. The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) currently has ten study groups, with the cooperation of infectious diseases specialists and microbiologists from different centres, with significant research activity. The program of Redes Temáticas de Investigación Cooperativa en Salud (Special Topics Cooperative Health Research Networks) is an appropriate framework for the strategic coordination of research groups from the Spanish autonomous communities. The Spanish Network for Research in Infectious Diseases (REIPI) and the Network for Research in AIDS (RIS) integrate investigators in Infectious Diseases from multiple groups, which continuously perform important research projects. Research using different experimental models in infectious diseases, in numerous institutions, is an important activity in our country. The analysis of the recent scientific production in Infectious Diseases shows that Spain has a good position in the context of the European Union. The research activity in Infectious Diseases carried out in our country is a great opportunity for the training of specialists in this area of knowledge. PMID:19195467

  9. Pharmacokinetics and Safety of FV-100, a Novel Oral Anti-Herpes Zoster Nucleoside Analogue, Administered in Single and Multiple Doses to Healthy Young Adult and Elderly Adult Volunteers▿

    PubMed Central

    Pentikis, Helen S.; Matson, Mark; Atiee, George; Boehlecke, Brian; Hutchins, Jeff T.; Patti, Joseph M.; Henson, Geoffrey W.; Morris, Amy

    2011-01-01

    FV-100 is the prodrug of the highly potent anti-varicella zoster virus bicyclic nucleoside analogue CF-1743. To characterize the pharmacokinetics and safety of oral FV-100, 3 randomized, double-blind, placebo-controlled clinical trials were conducted: (i) a single-ascending-dose study in 32 healthy subjects aged 18 to 55 years (100-, 200-, 400-, and 800-mg doses) with an evaluation of the food effect in the 400-mg group; (ii) a multiple-ascending-dose study in 48 subjects aged 18 to 55 years (100 mg once daily [QD], 200 mg QD, 400 mg QD, 400 mg twice a day, and 800 mg QD for 7 days); and (iii) a 2-part study in subjects aged 65 years and older with a single 400-mg dose in 15 subjects and a 400-mg QD dosing regimen for 7 days in 12 subjects. FV-100 was rapidly and extensively converted to CF-1743, the concentration of which remained above that required to reduce viral activity by 50% for the 24-hour dosing period. Renal excretion of CF-1743 was very low. A high-fat meal reduced exposure to CF-1743; a low-fat meal did not. Pharmacokinetic parameters for the elderly subjects were comparable to those for the younger subjects. FV-100 was well tolerated by all subjects. The pharmacokinetic and safety profiles of FV-100 support its continued investigation for the treatment of herpes zoster and prevention of postherpetic neuralgia with once-daily dosing and without dose modifications for elderly or renally impaired patients. PMID:21444712

  10. Severe perianal shingles during azathioprine and budesonide treatment for Crohn's disease-preventable with zoster vaccine?

    PubMed

    Elliott, Timothy Ross; Miller, Charles; Macrae, Finlay A

    2016-01-01

    Patients with inflammatory bowel disease (IBD), particularly those on immunosuppressive medications, suffer a high incidence of, and worse clinical outcomes relating to, herpes zoster (HZ) reactivation. We report on the presentation and management of a patient with Crohn's disease who developed severe perianal HZ after starting azathioprine and oral budesonide treatment. The zoster vaccine may prevent such zoster reactivation in patients with IBD. The zoster vaccine is effective in decreasing the risk of HZ in older adults but its role in younger adults and those with IBD has not been tested prospectively. A review of the potential risks and benefits of this live vaccine in patients with IBD and an approach to further determining its role in this patient population is discussed. PMID:27440857

  11. FastStats: Infectious Disease

    MedlinePlus

    ... this? Submit What's this? Submit Button NCHS Home Infectious Disease Recommend on Facebook Tweet Share Compartir Data are ... Health, United States trend tables with data on infectious disease Seroprevalence of six infectious diseases among adults in ...

  12. Herpes Zoster as a Predictor of HIV Infection in Taiwan: A Population-Based Study

    PubMed Central

    Lee, Yuan-Ti; Nfor, Oswald Ndi; Tantoh, Disline Manli; Huang, Jing-Yang; Ku, Wen-Yuan; Hsu, Shu-Yi; Ko, Pei-Chieh; Hung, Hung-Chang; Jan, Cheng-Feng; Liaw, Yung-Po

    2015-01-01

    This study aimed to investigate the association between herpes zoster (HZ) and human immunodeficiency virus (HIV). Data were retrieved from the Longitudinal Health Insurance Databases (LHID 2005 and 2010), Taiwan. The International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] codes were used to identify Hz from 2001–2004. Identification of HIV infection was from 2005–2010. The hazard ratios of HIV among herpes zoster infected and non-herpes zoster infected patients were estimated using multiple Cox proportional hazard model. In general, 19685 participants were identified with Hz. The HIV incidence rates (per 104 person-months) in herpes zoster infected and non-infected patients were 0.191(95% CI 0.130–0.280) and 0.079 (95% CI 0.074–0.084), respectively while the hazard ratio (HR) of HIV among infected individuals was 3.518 (95% CI 2.375–5.211). This study concludes that herpes zoster could be considered as a predictor of HIV infection especially among Asian populations, hence it is vital to test herpes zoster infected individuals for HIV antibodies. PMID:26535574

  13. Continuing Decline in Varicella Incidence After the 2-Dose Vaccination Recommendation—Connecticut, 2009–2014

    PubMed Central

    Mullins, Jocelyn; Kudish, Kathy; Sosa, Lynn; Hadler, Jim

    2015-01-01

    Background. Varicella is a highly contagious vaccine-preventable illness. In 1996, the Advisory Committee for Immunization Practices recommended 1 dose of vaccine for children, and in 2006 it recommended 2 doses; Connecticut required 1 dose for school entry in 2000 and 2 doses for school entry starting in 2011. Connecticut varicella incidence overall and among persons aged 1–14 years declined during 2005–2008. We analyzed varicella surveillance data for 2009–2014 to characterize overall and age group-specific trends in the setting of the 2-dose requirement. Methods. Passive surveillance was used to collect data and identify incidence trends and changes in proportions, and these were assessed by χ2 tests for trend and proportion, respectively. Results. Varicella incidence decreased from 13.8 cases/100 000 persons during 2009 to 5.1 cases/100 000 persons during 2014 (P < .001); significant declines in incidence occurred among children aged 1–4, 5–9, and 10–14 years (P < .01 for each age group). Cases classified as preventable decreased from 44% during 2009 to 25% during 2014 (P < .01); significant declines in percentages of preventable cases occurred only among those aged 5–9 years (P < .05) and 10–14 (P < .01) years. Conclusions. Varicella incidence continued to decline in Connecticut in the setting of the 2-dose school-entry program. Continued surveillance is needed to assess the full influence of the 2-dose recommendation. PMID:26609540

  14. Continuing Decline in Varicella Incidence After the 2-Dose Vaccination Recommendation-Connecticut, 2009-2014.

    PubMed

    Mullins, Jocelyn; Kudish, Kathy; Sosa, Lynn; Hadler, Jim

    2015-12-01

    Background.  Varicella is a highly contagious vaccine-preventable illness. In 1996, the Advisory Committee for Immunization Practices recommended 1 dose of vaccine for children, and in 2006 it recommended 2 doses; Connecticut required 1 dose for school entry in 2000 and 2 doses for school entry starting in 2011. Connecticut varicella incidence overall and among persons aged 1-14 years declined during 2005-2008. We analyzed varicella surveillance data for 2009-2014 to characterize overall and age group-specific trends in the setting of the 2-dose requirement. Methods.  Passive surveillance was used to collect data and identify incidence trends and changes in proportions, and these were assessed by χ(2) tests for trend and proportion, respectively. Results.  Varicella incidence decreased from 13.8 cases/100 000 persons during 2009 to 5.1 cases/100 000 persons during 2014 (P < .001); significant declines in incidence occurred among children aged 1-4, 5-9, and 10-14 years (P < .01 for each age group). Cases classified as preventable decreased from 44% during 2009 to 25% during 2014 (P < .01); significant declines in percentages of preventable cases occurred only among those aged 5-9 years (P < .05) and 10-14 (P < .01) years. Conclusions.  Varicella incidence continued to decline in Connecticut in the setting of the 2-dose school-entry program. Continued surveillance is needed to assess the full influence of the 2-dose recommendation. PMID:26609540

  15. Simple Technique for in Field Samples Collection in the Cases of Skin Rash Illness and Subsequent PCR Detection of Orthopoxviruses and Varicella Zoster Virus

    PubMed Central

    Magazani, Edmond K.; Garin, Daniel; Muyembe, Jean-Jacques T.; Bentahir, Mostafa; Gala, Jean-Luc

    2014-01-01

    Background In case of outbreak of rash illness in remote areas, clinically discriminating monkeypox (MPX) from severe form of chickenpox and from smallpox remains a concern for first responders. Objective The goal of the study was therefore to use MPX and chickenpox outbreaks in Democratic Republic of Congo (DRC) as a test case for establishing a rapid and specific diagnosis in affected remote areas. Methods In 2008 and 2009, successive outbreaks of presumed MPX skin rash were reported in Bena Tshiadi, Yangala and Ndesha healthcare districts of the West Kasai province (DRC). Specimens consisting of liquid vesicle dried on filter papers or crusted scabs from healing patients were sampled by first responders. A field analytical facility was deployed nearby in order to carry out a real-time PCR (qPCR) assay using genus consensus primers, consensus orthopoxvirus (OPV) and smallpox-specific probes spanning over the 14 kD fusion protein encoding gene. A PCR-restriction fragment length polymorphism was used on-site as backup method to confirm the presence of monkeypox virus (MPXV) in samples. To complete the differential diagnosis of skin rash, chickenpox was tested in parallel using a commercial qPCR assay. In a post-deployment step, a MPXV-specific pyrosequencing was carried out on all biotinylated amplicons generated on-site in order to confirm the on-site results. Results Whereas MPXV proved to be the agent causing the rash illness outbreak in the Bena Tshiadi, VZV was the causative agent of the disease in Yangala and Ndesha districts. In addition, each on-site result was later confirmed by MPXV-specific pyrosequencing analysis without any discrepancy. Conclusion This experience of rapid on-site dual use DNA-based differential diagnosis of rash illnesses demonstrates the potential of combining tests specifically identifying bioterrorism agents and agents causing natural outbreaks. This opens the way to rapid on-site DNA-based identification of a broad spectrum of causative agents in remote areas. PMID:24841633

  16. Microgravity Analogues of Herpes Virus Pathogenicity: Human Cytomegalovirus (hCMV) and Varicella Zoster (VZV) Infectivity in Human Tissue Like Assemblies (TLAs)

    NASA Technical Reports Server (NTRS)

    Goodwin, T. J.; McCarthy, M.; Albrecht, T.; Cohrs, R.

    2009-01-01

    The old adage we are our own worst enemies may perhaps be the most profound statement ever made when applied to man s desire for extraterrestrial exploration and habitation of Space. Consider the immune system protects the integrity of the entire human physiology and is comprised of two basic elements the adaptive or circulating and the innate immune system. Failure of the components of the adaptive system leads to venerability of the innate system from opportunistic microbes; viral, bacteria, and fungal, which surround us, are transported on our skin, and commonly inhabit the human physiology as normal and imunosuppressed parasites. The fine balance which is maintained for the preponderance of our normal lives, save immune disorders and disease, is deregulated in microgravity. Thus analogue systems to study these potential Risks are essential for our progress in conquering Space exploration and habitation. In this study we employed two known physiological target tissues in which the reactivation of hCMV and VZV occurs, human neural and lung systems created for the study and interaction of these herpes viruses independently and simultaneously on the innate immune system. Normal human neural and lung tissue analogues called tissue like assemblies (TLAs) were infected with low MOIs of approximately 2 x 10(exp -5) pfu hCMV or VZV and established active but prolonged low grade infections which spanned .7-1.5 months in length. These infections were characterized by the ability to continuously produce each of the viruses without expiration of the host cultures. Verification and quantification of viral replication was confirmed via RT_PCR, IHC, and confocal spectral analyses of the respective essential viral genomes. All host TLAs maintained the ability to actively proliferate throughout the entire duration of the experiments as is analogous to normal in vivo physiological conditions. These data represent a significant advance in the ability to study the triggering mechanisms which surround Herpes vial reactivation and proliferation. Additionally, prolonged replication of these viruses will allow the tracking of viral genomic shift.

  17. Varicella-zoster virus (VZV) origin of DNA replication oriS influences origin-dependent DNA replication and flanking gene transcription.

    PubMed

    Khalil, Mohamed I; Sommer, Marvin H; Hay, John; Ruyechan, William T; Arvin, Ann M

    2015-07-01

    The VZV genome has two origins of DNA replication (oriS), each of which consists of an AT-rich sequence and three origin binding protein (OBP) sites called Box A, C and B. In these experiments, the mutation in the core sequence CGC of the Box A and C not only inhibited DNA replication but also inhibited both ORF62 and ORF63 expression in reporter gene assays. In contrast the Box B mutation did not influence DNA replication or flanking gene transcription. These results suggest that efficient DNA replication enhances ORF62 and ORF63 transcription. Recombinant viruses carrying these mutations in both sites and one with a deletion of the whole oriS were constructed. Surprisingly, the recombinant virus lacking both copies of oriS retained the capacity to replicate in melanoma and HELF cells suggesting that VZV has another origin of DNA replication. PMID:25795313

  18. Primary cutaneous dermal mucinosis on herpes zoster scars.

    PubMed

    Camacho, Diana; Feltes, Federico; Machán, Salma; Pielasinski, Úrsula; Fariña, María C; Gavin, Eduardo; Requena, Luis

    2016-07-01

    The term isotopic response refers to the appearance of a new skin disease at the site of another unrelated and already healed skin disorder. Often, the first disease is herpes zoster (HZ). Several cutaneous reactions have been described in a dermatome recently affected by HZ. We present the case of a 33-year-old man who developed whitish papules with a zosteriform distribution on HZ scars. Histopathologic study with hematoxylin and eosin and Alcian blue (pH 2.5) staining demonstrated abundant deposits of mucin interstitially arranged between collagen bundles of the papillary dermis. Cutaneous dermal mucinosis as a postherpetic isotopic response is rare, but it should be added to the list of cutaneous reactions arising in HZ scars. PMID:27529717

  19. Neurotoxic effects during vidarabine therapy for herpes zoster.

    PubMed Central

    Burdge, D R; Chow, A W; Sacks, S L

    1985-01-01

    Two cases of neurotoxic effects resulting from therapy with vidarabine are described. Both patients were undergoing treatment for cutaneously disseminated herpes zoster complicating therapy for solid malignant tumours. Both had normal renal function. The serum levels of hepatic enzymes were normal in one patient and slightly elevated in the other. Neurotoxicity was first manifested in both patients by the development of intention tremors that progressed to gross tremors. Obtundation, coma and death ensued in one patient and pain syndromes in the other. Vidarabine-induced neurotoxic effects, which may occur in the absence of hepatic or renal dysfunction or treatment with another drug, may be mild initially but may progress rapidly to more serious, even life-threatening, conditions. Presentation of neurotoxic effects should be considered an indication for withdrawal of vidarabine. PMID:3971255

  20. Cutaneous lupus after herpes zoster: isomorphic, isotopic, or both?

    PubMed

    Lee, Nicole Y; Daniel, Alyssa S; Dasher, David A; Morrell, Dean S

    2013-01-01

    Koebner isomorphic response describes the phenomenon of histopathologically identical skin lesions of a preceding cutaneous disease appearing in sites of trauma. Wolf isotopic response describes the phenomenon of a new skin disease appearing in the site of an unrelated cutaneous disease. Neither of the phenomena has been reported in relation to systemic lupus erythematosus. This report describes a 17-year-old girl with systemic lupus erythematosus exhibiting particularly severe cutaneous involvement confined primarily to sun-exposed areas presenting with a dermatomal band of atrophic, scaling, erythematous papules, and plaques on her left shoulder extending down her left arm after herpes zoster eruption. The histopathologil result showed lupus erythematosus. This phenomenon is best considered as a Koebner isomorphic response, although Wolf isotopic response has some clinical relevance as well. Koebner isomorphic and Wolf isotopic responses are discussed as related to this case. PMID:22639953

  1. Non-Infectious Meningitis

    MedlinePlus

    ... Resources for Healthcare Professionals Related Links Vaccine Schedules Preteen & Teen Vaccines Meningococcal Disease Sepsis Non-Infectious Meningitis ... confusion) Top of Page Related Links Vaccine Schedules Preteen & Teen Vaccines Meningococcal Disease Sepsis File Formats Help: ...

  2. Modeling Infectious Diseases

    MedlinePlus

    ... MIDAS models require a breadth of knowledge, the network draws together an interdisciplinary team of researchers with expertise in epidemiology, infectious diseases, computational biology, statistics, social sciences, physics, computer sciences and informatics. In 2006, MIDAS modelers simulated ...

  3. Famciclovir for ophthalmic zoster: a randomised aciclovir controlled study

    PubMed Central

    Tyring, S.; Engst, R.; Corriveau, C.; Robillard, N.; Trottier, S.; Van Slycken, S.; Crann, R.; Locke, L.; Saltzman, R.; Palestine, A.

    2001-01-01

    AIMS—To compare the efficacy and safety of famciclovir with aciclovir for the treatment of ophthalmic zoster.
METHODS—Randomised, double masked, aciclovir controlled, parallel group in 87 centres worldwide including 454 patients with ophthalmic zoster of trigeminal nerve (V1) comprised the intent to treat population. Oral famciclovir 500 mg three times daily or oral aciclovir 800 mg five times daily for 7 days. Assessments included day 0 (screening), days 3 and 7 (during treatment), days 10, 14, 21, 28 and monthly thereafter, up to 6 months (follow up). Proportion of patients who experienced ocular manifestations, severe manifestations and non-severe manifestations; loss of visual acuity was the main outcome measure.
RESULTS—The percentage of patients who experienced one or more ocular manifestations was similar for famciclovir (142/245, 58.0%) and aciclovir (114/196, 58.2%) recipients, with no significant difference between groups (OR 0.99; 95% CI 0.68, 1.45). The percentage of patients who experienced severe and non-severe manifestations was similar between groups, with no significant difference. The prevalence of individual ocular manifestations was comparable between groups. There was no significant difference between groups for visual acuity loss.
CONCLUSION—Famciclovir 500 mg three times daily was well tolerated and demonstrated efficacy similar to aciclovir 800 mg five times daily.

 PMID:11316720

  4. Infectious optic neuropathy.

    PubMed

    Golnik, Karl C

    2002-03-01

    A wide variety of infectious agents are known to cause optic neuropathy. This article will consider the bacteria, spirochetes, fungi, and viruses that most commonly affect the optic nerve. Clinical presentation is variable, but some pathogens often produce a characteristic funduscopic pattern. Diagnosis is usually made on the basis of clinical suspicion and serologic testing. Polymerase chain reaction is also increasingly utilized. Most infectious agents can be effectively treated but visual recovery is highly variable. PMID:15513450

  5. Ethics and infectious disease.

    PubMed

    Selgelid, Michael J

    2005-06-01

    Bioethics apparently suffers from a misdistribution of research resources analogous to the '10/90' divide in medical research. Though infectious disease should be recognized as a topic of primary importance for bioethics, the general topic of infectious disease has received relatively little attention from the discipline of bioethics in comparison with things like abortion, euthanasia, genetics, cloning, stem cell research, and so on. The fact that the historical and potential future consequences of infectious diseases are almost unrivalled is one reason that the topic of infectious disease warrants more attention from bioethicists. The 'Black Death' eliminated one third of the European population during the 14th Century; the 1989 flu killed between 20 and 100 million people; and, in the 20th Century smallpox killed perhaps three times more people than all the wars of that period. In the contemporary world, epidemics (AIDS, multi-drug resistant turberculosis, and newly emerging infectious diseases such as SARS) continue to have dramatic consequences. A second reason why the topic of infectious disease deserves further attention is that it raises difficult ethical questions of its own. While infected individuals can threaten the health of other individuals and society as a whole, for example, public health care measures such as surveillance, isolation, and quarantine can require the infringement of widely accepted basic human rights and liberties. An important and difficult ethical question asks how to strike a balance between the utilitarian aim of promoting public health, on the one hand, and libertarian aims of protecting privacy and freedom of movement, on the other, in contexts involving diseases that are--to varying degrees--contagious, deadly, or otherwise dangerous. Third, since their burden is most heavily shouldered by the poor (in developing countries), infectious diseases involve issues of justice--which should be a central concern of ethics. I conclude

  6. Fight against infectious diseases.

    PubMed

    Soda, K; Kamakura, M; Kitamura, K

    1996-08-01

    During early Meiji era in Japan, there were frequent epidemics of fatal acute communicable diseases such as cholera, dysentery and smallpox, and preventive measures and preparations for acute infectious diseases were urgently needed. Together with improvement of scientific preparations, the Communicable Disease Prevention Law was promulgated in 1897. Then gradually until 1940's, the focus of preventive measures have been shifted from acute infectious diseases to chronic ones, particularly tuberculosis. After the World War II, except the short period of social confusion, major legally-defined communicable diseases had been decreasing rapidly mainly due to the use of antibiotics and improvement of environmental sanitation. At the same time, the introduction of preventive vaccination marked a new era for the prevention of infectious diseases and was largely responsible for the remarkable decrease of infant mortality in Japan. Recently the concept of defense by vaccination against infectious diseases has evolved from group-oriented to individual-oriented, so that the Preventive Vaccination Law was drastically revised in 1994. Currently, effective counter-measures against newly emerged infectious diseases, as viral hepatitis, institution-acquired infection, viral hemorrhagic fever etc., have been implemented. For the future, improvement of infections disease surveillance, vaccine development and expansion of vaccination coverage along with monitoring side-effects, preventive health education on AIDS/STDs, addressing the special needs of foreigners living in Japan and international collaboration for disease control abroad are all vital to the success of protection of the public's health from infectious diseases in Japan. PMID:8800275

  7. Infectious complications more than 1 year after liver transplantation: a 3-decade nationwide experience.

    PubMed

    Aberg, F; Mäkisalo, H; Höckerstedt, K; Isoniemi, H

    2011-02-01

    Because few reports have addressed infections late (≥1 year) after liver transplantation (LT), we evaluated the incidence, risk factors and pathogens involved. Infection data were from the Finnish LT registry, with starting date, type and relevant pathogens for 501 Finnish adult LT patients surviving ≥1 year post-transplant. Follow-up end points were end of study, death or retransplantation. Logistic regression to assess risk factors was adjusted for age, gender and follow-up time. With 3923 person-years of follow-up, overall infection incidence was 66/1000 person-years; 155 (31%) suffered 259 infections, and two-thirds experienced only one infection. Cholangitis (20%), pneumonia (19%) and sepsis (14%) were most common. The most frequent bacteria were Enterococcus spp. and Escherichia coli, and the most frequent viruses cytomegalovirus and varicella zoster virus. Fungal infections were rare (n = 7). With 13 fatal infections, 17% of all late deaths involved infection. Primary sclerosing cholangitis (PSC) and Roux-en-Y-type biliary anastomosis were associated with cholangitis; 18% of PSC patients suffered late cholangitis. Late acute rejection was associated with sepsis. Age, gender or cytomegalovirus did not significantly influence late infections. In conclusion, although infection risk under maintenance immunosuppression therapy is relatively low, particular vigilance regarding cholangitis, pneumonia and sepsis seems appropriate. PMID:21219571

  8. Correlated infections: quantifying individual heterogeneity in the spread of infectious diseases.

    PubMed

    Farrington, C Paddy; Whitaker, Heather J; Unkel, Steffen; Pebody, Richard

    2013-03-01

    In this paper, we propose new methods for investigating the extent of heterogeneity in effective contact rates relevant to the transmission of infections. These methods exploit the correlations between ages at infection for different infections within individuals. The methods are developed for serological surveys, which provide accessible individual data on several infections, and are applied to a wide range of infections. We find that childhood infections are often highly correlated within individuals in early childhood, with the correlations persisting into adulthood only for infections sharing a transmission route. We discuss 2 applications of the methods: 1) to making inferences about routes of transmission when these are unknown or uncertain and 2) to estimating epidemiologic parameters such as the basic reproduction number and the critical immunization threshold. Two examples of such applications are presented: elucidating the transmission route of polyomaviruses BK and JC and estimating the basic reproduction number and critical immunization coverage of varicella-zoster infection in Belgium, Italy, Poland, and England and Wales. We speculate that childhood correlations stem from confounding of different transmission routes and represent heterogeneity in childhood circumstances, notably nursery-school attendance. In contrast, it is suggested that correlations in adulthood are route-specific. PMID:23403987

  9. Herpes Zoster Infections in SLE in a University Hospital in Saudi Arabia: Risk Factors and Outcomes.

    PubMed

    Sayeeda, Afsar; Al Arfaj, Hussain; Khalil, Najma; Al Arfaj, A S

    2011-01-01

    Patients with SLE carry an increased risk of infection that account for 11-23% of all hospitalized patients and 50% of all SLE patients develop major infections during the course of their disease. Globally Herpes Zoster has been reported as the most frequent viral infection in SLE patients. We determined the clinical spectrum, disease sequelae and the risk factors associated with the development of Herpes Zoster in patients with SLE and their outcomes. Retrospective case control study of Herpes Zoster infections was done in SLE patients between 1982 and 2006. Cases were matched 1:2 to controls for age, race, sex and duration of follow up. Clinical features of the cases from the time of lupus diagnosis to the time of Zoster were compared to their respective controls over similar time periods. Thirty two SLE cases were compared to sixty four controls. Cases were more likely to have received cyclophosphamide (P = .0223) and intravenous methylprednisolone pulse therapy (P = .0026), MMF (P < .02), had leucopenia (P = .0407) and hemolytic anemia (P = .0344). More cases than controls had lupus nephritis, cerebritis, thrombocytopenia but the differences did not reach statistical significance. The mean oral prednisolone dose and proportion of patients receiving immunosuppressives including pulse methylprednisolone therapy, IV Cyclophosphamide and mycophenolate was significantly higher in patients with active SLE compared to patients with SLE in remission at the time of Herpes Zoster (P < .05). Disseminated Zoster developed in patients with active SLE (7/9) compared to patients with SLE in remission (0/23). None of the patients had postherpetic neuralgia or bacterial super infection. Immunosuppressive medications were discontinued at the time of diagnosis of Zoster in 19 of 32 patients and all patients received antiviral medications.There were no permanent neurologic deficits or deaths. We conclude that Herpes Zoster infections occur at increased frequency among patients

  10. Incidence of Herpes Zoster and Persistent Post-Zoster Pain in Adults With or Without Diabetes in the United States

    PubMed Central

    Suaya, Jose A.; Chen, Shih-Yin; Li, Qian; Burstin, Stuart J.; Levin, Myron J.

    2014-01-01

    Background  This study was designed to assess the association between diabetes and herpes zoster (HZ) and persistent post-zoster pain (PPZP). Methods  We used a United States-based, 2005–2009 retrospective observational study of medical and pharmacy claims from adults in 3 large national databases. Incidence rate ratios were used to compare HZ incidence by diabetes status. Multivariate regressions assessed the age and sex-adjusted risk of diabetes on HZ and PPZP as a function of immune competence. National projections of HZ and PPZP cases were obtained. Results  Among 51 million enrollees (∼88 million person-years [PYs] at risk), we identified 420 515 HZ cases. Patients with diabetes represented 8.7% of the PYs analyzed but accounted for 14.5% of the HZ cases and 20.3% of the PPZP cases. The crude incidence of HZ was 78% higher (7.96 vs 4.48 cases/1000 PY; P < .01) and the rate of PPZP was 50% higher (5.97% vs 3.93%; P < .01) in individuals with diabetes than without. Individuals with diabetes had 45% higher adjusted risk of HZ (hazard ratio [HR] = 1.45; 95% confidence intervals [CIs], 1.43–1.46) and 18% higher adjusted odds of PPZP (odds ratio = 1.18; 95% CI, 1.13–1.24). The risk of HZ associated with diabetes among immune-compromised individuals was weaker (HR = 1.10; 95% CI, 1.07–1.14) and the risk of PPZP was no longer significant. Every year, approximately 1.2 million HZ cases occur in US adults, 13% of these occur in individuals with diabetes. Conclusions  Diabetes is a risk factor for HZ and PPZP in the US adult population. This association is stronger in immune-competent individuals. PMID:25734121

  11. Fatal varicella hepatitis in an asthmatic adult after short-term corticosteroid treatment.

    PubMed

    Hyvernat, Hervé; Roger, Pierre-Marie; Pereira, Cécile; Saint-Paul, Marie Christine; Vandenbos, Frédéric; Bernardin, Gilles

    2005-09-01

    A 28-year-old male patient, treated with prednisone for bronchitis with sibilant rales, developed fever with abdominal pain and generalized vesicular rash after coming in contact with varicella-infected children. He was hospitalized after having a seizure. Laboratory values revealed hepatitis and rapidly fulminant hepatic insufficiency with disseminated intravascular coagulation. Despite acyclovir treatment, the patient died 4 days after admission. Clinical presentation could evoke a Reye's syndrome, but liver biopsy showed massive coagulative necrosis. This report demonstrates the increased risk of complicated varicella associated with the use of corticosteroids, even for a short period of time. PMID:16137553

  12. Quantification of risk factors for postherpetic neuralgia in herpes zoster patients

    PubMed Central

    Bhaskaran, Krishnan; Thomas, Sara L.; Smeeth, Liam; Clayton, Tim; Mansfield, Kathryn; Minassian, Caroline; Langan, Sinéad M.

    2016-01-01

    Objective: To investigate risk factors for postherpetic neuralgia, the neuropathic pain that commonly follows herpes zoster. Methods: Using primary care data from the Clinical Practice Research Datalink, we fitted multivariable logistic regression models to investigate potential risk factors for postherpetic neuralgia (defined as pain ≥90 days after zoster, based on diagnostic or prescription codes), including demographic characteristics, comorbidities, and characteristics of the acute zoster episode. We also assessed whether the effects were modified by antiviral use. Results: Of 119,413 zoster patients, 6,956 (5.8%) developed postherpetic neuralgia. Postherpetic neuralgia risk rose steeply with age, most sharply between 50 and 79 years (adjusted odds ratio [OR] for a 10-year increase, 1.70, 99% confidence interval 1.63–1.78). Postherpetic neuralgia risk was higher in women (6.3% vs 5.1% in men: OR 1.19, 1.10–1.27) and those with severely immunosuppressive conditions, including leukemia (13.7%: 2.07, 1.08–3.96) and lymphoma (12.7%: 2.45, 1.53–3.92); autoimmune conditions, including rheumatoid arthritis (9.1%: 1.20, 0.99–1.46); and other comorbidities, including asthma and diabetes. Current and ex-smokers, as well as underweight and obese individuals, were at increased risk of postherpetic neuralgia. Antiviral use was not associated with postherpetic neuralgia (OR 1.04, 0.97–1.11). However, the increased risk associated with severe immunosuppression appeared less pronounced in patients given antivirals. Conclusions: Postherpetic neuralgia risk was increased for a number of patient characteristics and comorbidities, notably with age and among those with severe immunosuppression. As zoster vaccination is contraindicated for patients with severe immunosuppression, strategies to prevent zoster in these patients, which could include the new subunit zoster vaccine, are an increasing priority. PMID:27287218

  13. Emergent Infectious Uveitis

    PubMed Central

    Khairallah, Moncef; Jelliti, Bechir; Jenzeri, Salah

    2009-01-01

    Infectious causes should always be considered in all patients with uveitis and it should be ruled out first. The differential diagnosis includes multiple well-known diseases including herpes, syphilis, toxoplasmosis, tuberculosis, bartonellosis, Lyme disease, and others. However, clinicians should be aware of emerging infectious agents as potential causes of systemic illness and also intraocular inflammation. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. This review recapitulates the systemic and ocular mainfestations of several emergent infectious diseases relevant to the ophthalmologist including Rickettsioses, West Nile virus infection, Rift valley fever, dengue fever, and chikungunya. Retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement have been associated with these emergent infectious diseases. The diagnosis of any of these infections is usually based on pattern of uveitis, systemic symptoms and signs, and specific epidemiological data and confirmed by detection of specific antibody in serum. A systematic ocular examination, showing fairly typical fundus findings, may help in establishing an early clinical diagnosis, which allows prompt, appropriate management. PMID:20404989

  14. Shingles - aftercare

    MedlinePlus

    Herpes zoster - treatment ... Shingles is a painful, blistering skin rash that is caused by the varicella-zoster virus. This is the same virus that causes chickenpox. Shingles is also called herpes zoster.

  15. Meteorological factors and El Nino Southern Oscillation are associated with paediatric varicella infections in Hong Kong, 2004-2010.

    PubMed

    Chan, J Y C; Lin, H L; Tian, L W

    2014-07-01

    Varicella accounts for substantial morbidities and remains a public health issue worldwide, especially in children. Little is known about the effect of meteorological variables on varicella infection risk for children. This study described the epidemiology of paediatric varicella notifications in Hong Kong from 2004 to 2010, and explored the association between paediatric varicella notifications in children aged <18 years and various meteorological factors using a time-stratified case-crossover model, with adjustment of potential confounding factors. The analysis found that daily mean temperature, atmospheric pressure and Southern Oscillation Index (SOI) were positively associated with paediatric varicella notifications. We found that an interquartile range (IQR) increase in temperature (8·38°C) at lag 1 day, a 9·50 hPa increase in atmospheric pressure for the current day, and a 21·91 unit increase in SOI for the current day may lead to an increase in daily cases of 5·19% [95% confidence interval (CI) 1·90-8·58], 5·77% (95% CI 3·01-8·61), and 4·32% (95% CI 2·98-5·68), respectively. An IQR increase in daily relative humidity (by 11·96%) was associated with a decrease in daily paediatric varicella (-2·79%, 95% CI -3·84 to -1·73). These findings suggest that meteorological factors might be important predictors of paediatric varicella infection in Hong Kong. PMID:24074377

  16. Prodromal odontalgia and multiple devitalized teeth caused by a herpes zoster infection of the trigeminal nerve: report of case.

    PubMed

    Goon, W W; Jacobsen, P L

    1988-04-01

    A case of oral herpes zoster infection with prodromal odontalgia is presented. Tooth devitalization, facial scarring, and neuralgia occurred without concurrent local and systemic factors. The cause, pathological features, diagnosis, and management of an oral herpes zoster infection with prodromal odontalgia are discussed. PMID:3164018

  17. Forecasting Infectious Disease Outbreaks

    NASA Astrophysics Data System (ADS)

    Shaman, J. L.

    2015-12-01

    Dynamic models of infectious disease systems abound and are used to study the epidemiological characteristics of disease outbreaks, the ecological mechanisms affecting transmission, and the suitability of various control and intervention strategies. The dynamics of disease transmission are non-linear and consequently difficult to forecast. Here, we describe combined model-inference frameworks developed for the prediction of infectious diseases. We show that accurate and reliable predictions of seasonal influenza outbreaks can be made using a mathematical model representing population-level influenza transmission dynamics that has been recursively optimized using ensemble data assimilation techniques and real-time estimates of influenza incidence. Operational real-time forecasts of influenza and other infectious diseases have been and are currently being generated.

  18. Infectious Chronic Rhinosinusitis.

    PubMed

    Bose, Sumit; Grammer, Leslie C; Peters, Anju T

    2016-01-01

    Chronic rhinosinusitis (CRS) is a persistent inflammatory disease that affects a multitude of people worldwide. The pathogenesis of CRS involves many factors including genetics, status of the sinonasal microbiome, infections, and environmental influences. Comorbidities associated with CRS include asthma, allergic rhinitis, bronchiectasis, and certain kinds of immunodeficiency. CRS can be divided into different subtypes based on endotypes and phenotypes. Infectious CRS is one such category. The etiology of infectious CRS is usually secondary to chronic bacterial infection that commonly begins with a viral upper respiratory tract infection. Humoral antibody deficiencies can underlie difficult-to-treat or recurrent CRS. Infectious CRS can be treated with antimicrobials, topical or oral corticosteroids, and nasal saline irrigations. Patients with CRS and humoral immunodeficiency may require an aggressive treatment approach including immunoglobulin replacement therapy. Despite advancements in the field of CRS, targeted therapies and reliable biomarkers are still lacking. PMID:27393772

  19. Acute herpes zoster and postherpetic neuralgia: effects of acyclovir and outcome of treatment with amitriptyline.

    PubMed Central

    Bowsher, D

    1992-01-01

    This retrospective study was designed to assess the effects of acyclovir treatment of acute herpes zoster on subsequent postherpetic neuralgia, and to examine the effects of amitriptyline in the treatment of postherpetic neuralgia. Eighty seven patients with postherpetic neuralgia of three or more months' duration were studied: 24 of them had had their herpes zoster treated with oral acyclovir. At first presentation, only 25% of the 24 patients who had had their herpes zoster treated with acyclovir selected the word group containing burning on the McGill pain questionnaire compared with 76% of the 63 patients who had not received acyclovir. A higher proportion of patients who had had acyclovir than had not selected the word group which contains the word aching (63% versus 49%). Acyclovir thus appears to change the nature of postherpetic neuralgia. Postherpetic neuralgia was treated with amitriptyline, alone or in combination with distigmine and/or sodium valproate. There was a strong correlation between pain relief and the interval between the occurrence of herpes zoster and the initiation of treatment with amitriptyline--early treatment is almost twice as likely to be successful as late. Since conventional analgesics and sympatholytic drugs are of no benefit in the treatment of established postherpetic neuralgia, the sequelae of herpes zoster must, therefore, be recognized and treated with amitriptyline as soon as possible. PMID:1419247

  20. Infectious waste feed system

    DOEpatents

    Coulthard, E. James

    1994-01-01

    An infectious waste feed system for comminuting infectious waste and feeding the comminuted waste to a combustor automatically without the need for human intervention. The system includes a receptacle for accepting waste materials. Preferably, the receptacle includes a first and second compartment and a means for sealing the first and second compartments from the atmosphere. A shredder is disposed to comminute waste materials accepted in the receptacle to a predetermined size. A trough is disposed to receive the comminuted waste materials from the shredder. A feeding means is disposed within the trough and is movable in a first and second direction for feeding the comminuted waste materials to a combustor.