Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: A case report

BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV can lead to various neurological complications,including transverse myelitis(TM);although cases of the latter are very rare,particularly in newly active VZV infection.CASE SUMMARY We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection.The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period.Cerebrospinal fluid testing was denied,but findings from magnetic resonance imaging and collective symptomology indicated TM.He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned,necessitating multiple hospital admissions.After about a month of repeated treatments,he was deemed sufficiently improved for hospital discharge to home.CONCLUSION VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.

Varicella-zoster virus meningitis after spinal anesthesia:A case report

BACKGROUND Headache is a common complication of regional anesthesia.The treatment of post spinal anesthesia headache varies depending on the cause.Although meningitis is rare,it can cause significant harm to the patient.Post dural puncture headache and septic meningitis are the most commonly suspected causes of post spinal anesthesia headache;however,other causes should also be considered.CASE SUMMARY A 69-year-old woman was scheduled for varicose vein stripping surgery under spinal anesthesia.The procedure was performed aseptically,and surgery was completed without any complications.After 4 d,the patient visited the emergency room with complaints of headache,nausea,and anorexia.Clinical examination revealed that the patient was afebrile.Considering the history of spinal anesthesia,post dural puncture headache and septic meningitis was initially suspected,and the patient was treated with empirical antibiotics.Subsequently,varicella-zoster virus PCR test result was positive,and all other test results were negative.The patient was diagnosed with meningitis caused by varicella-zoster virus and was treated with acyclovir for 5 d.The headache improved,and the patient was discharged without any problems.CONCLUSION Viral meningitis due to virus reactivation may cause headache after regional anesthesia.Therefore,clinicians should consider multiple etiologies of headache.

Detection of Varicella Zoster Virus DNA within Lesions and Healed Skin Lesions of Herpes Zoster by PCR

Varicella zoster virus(VZV) DNA in blister lesions and skin biopsies obtained from healed skin lesions in 16 patients with herpes zoster was detected using polymerase chain reaction. A 385 bp VZV DNA fragment was found in all the blister lesions and in two of six biopsies from the skin lesions healed within two months by PCR. No VZV DNA was found in the skin lesions more than two months after healing in 10 cases of herpes zoster. VZV DNA may be detected at the sites of resolved herpes zoster lesions within short duration.

Management strategies for common viral infections in pediatric renal transplant recipients

Viral infections have been considered as a major cause of morbidity and mortality after kidney transplantation in pediatric cohort.Children are at high risk of acquiring virus-related complications due to immunological immaturity and the enhanced alloreactivity risk that led to maintenance of high immunosuppressive regimes.Hence,prevention,early detection,and prompt treatment of such infections are of paramount importance.Among all viral infections,herpes viruses(herpes simplex virus,varicella zoster virus,Epstein-Barr virus,cytomegalovirus),hepatitis B and C viruses,BK polyomavirus,and respiratory viruses(respiratory syncytial virus,parainfluenza virus,influenza virus and adenovirus)are common in kidney transplant recipients.These viruses can cause systemic disease or allograft dysfunction affecting the clinical outcome.Recent advances in technology and antiviral therapy have improved management strategies in screening,monitoring,adoption of prophylactic or preemptive therapy and precise treatment in the immunocompromised host,with significant impact on the outcome.This review discusses the etiology,screening and monitoring,diagnosis,prevention,and treatment of common viral infections in pediatric renal transplant recipients.

Severe autoimmune hepatitis triggered by varicella zoster infection

Autoimmune hepatitis (AIH) is a chronic disease of unknown etiology that is characterized by the presence of circulatory autoantibodies and inflammatory histological changes in the liver. Although the pathogenesis of AIH is not known, it is thought that, in a genetically predisposed individual, environmental factors such as viruses can trigger the autoimmune process. Herpes simplex virus, Epstein-Barr virus, measles virus, and hepatitis viruses are thought to play a role in the etiology of AIH. Proteins belonging to these viruses may be similar to the amino acid chains of different autoantigens in the liver, this causes immune cross reactions and liver tissue damage. We report a case of severe AIH following varicella zoster infection in a 23-year-old man, and speculate that, based on the molecular mimicry hypothesis, the liver damage was caused by an immune cross reaction to the viral proteins. Varicella-zoster-induced AIH has not been reported previously.

Atypical Presentation of Ramsay Hunt Syndrome without Facial Palsy in an Immunocompetent Senegalese Adulte Patient

First described in 1907 by James Ramsay Hunt, Ramsay Hunt syndrome is a recurrence (reactivation) of varicella-zoster virus (VZV) affecting the geniculate ganglion, secondary to a decrease in cell-mediated immunity. The strict definition of Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by erythematous vesicular rash on the ear. We report a 57-year-old female immunocompetent patient complaining of otalgia, small vesicles on the Ramsey Hunt Zone. She does not complain fever, hearing loss, nausea, vomiting or dizziness. There was no peripheral facial nerve palsy, no reduction of taste sensation, no ataxia or nystagmus, Romberg sign was negative. Our patient targets two of the three criteria needed for the diagnosis of Ramsay Hunt syndrome. She began to take Acyclovir-Steroid (AS) therapy very early with good outcome. This suggests that prompt diagnosis and management improve outcome and prevent occurrence of nerve palsy in Ramsay Hunt syndrome.

Weeks-Ahead Epidemiological Predictions of Varicella Cases From Univariate Time Series Data Applying Artificial Intelligence

Background:"Chickenpox"is a highly infectious disease caused by the varicella-zoster virus,influenced by seasonal and spatial factors.Dealing with varicella-zoster epidemics can be a substantial drain on health-authority resources.Methods that improve the ability to locally predict case numbers from time-series data sets every week are therefore worth developing.Methods:Simple-to-extract trend attributes from published univariate weekly case-number univariate data sets were used to generate multivariate data for Hungary covering 10 years.That attribute-enhanced data set was assessed by machine learning(ML)and deep learning(DL)models to generate weekly case forecasts from next week(t0)to 12 weeks forward(t+12).The ML and DL predictions were compared with those generated by multilinear regression and univariate prediction methods.Results:Support vector regression generates the best predictions for weeks t0 and t+1,whereas extreme gradient boosting generates the best predictions for weeks t+3 to t+12.Long-short-term memory only provides comparable prediction accuracy to the ML models for week t+12.Multi-K-fold cross validation reveals that overall the lowest prediction uncertainty is associated with the tree-ensemble ML models.Conclusion:The novel trend-attribute method offers the potential to reduce prediction errors and improve transparency for chickenpox timeseries.

酶联免疫吸附试验间接法检测水痘带状疱疹病毒IgG抗体方法的建立及应用

以 1号水痘带状疱疹病毒 (VZV1)为毒种 ,制备酶联免疫吸附试验特异抗原 ,并以Vero E6基质细胞抗原作对照 ,用ELISA间接法测定VZVIgG抗体。方法特异性经中和试验、封闭性阻断试验 ,检测带状疱疹病人双份血清抗体滴度比较证实 ;其敏感性比间接免疫荧光法 (IFA)高数十倍 ;重现性经 48份血清 3次重复测定平均OD值无显著差异。与Bioseed抗VZV抗体IgGELISA试剂盒测定结果比较阳性符合率为97 8% ,表明ELISA检测VZVIgG抗体特异性好 ,敏感 ,结果稳定 ,可作为VZV血清流行病学调查的首选方法。

儿童肾脏病合并水痘-带状疱疹病毒感染的防治

目的 :探讨儿童肾脏病合并水痘 -带状疱疹病毒感染的治疗和预防。方法 :分析合并水痘感染的 10例肾脏病患儿 ,其中微小病变型 3例 ,系膜增殖性肾小球肾炎 6例 ,系膜增殖性伴新月体形成 1例 ;有中轻度水痘感染者 9例 ,重度水痘感染者 1例。用干扰素无环鸟苷、丙种球蛋白或血浆、鲜血、血小板悬液治疗 7d。结果 :9例治愈 ,1例死亡。 10例患儿实验室检查IgG、C3、C4 均低下。结论 :肾脏病患儿免疫功能低下 ,应用糖皮质激素等免疫抑制剂和细胞毒类药物后 ,易感染水痘病毒 ,应用干扰素、无环鸟苷等治疗有效。

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

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.

Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study:A case report

BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus.Herpes zoster radiculopathy,which is a type of segmental zoster paresis,can complicate the disease and cause motor weakness.This complication should be considered when a patient with a rash complains of acute-onset motor weakness,and the diagnosis can be verified via electrodiagnostic study.CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain,an itching sensation,and a rash on the right anterior shoulder that had begun 5 d prior.Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions.Because herpes zoster was suspected,the patient immediately received intravenous acyclovir.On the third hospital day,she complained of motor weakness in the right upper extremity.Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression.On the 12th hospital day,electrodiagnostic study revealed right cervical radiculopathy,mainly in the C5/6 roots.Six months later,monoparesis resolved,and follow-up electrodiagnostic study was normal.CONCLUSION This case emphasizes that clinicians should consider the possibility of postherpetic paresis,such as herpes zoster radiculopathy,and that electrodiagnostic study is useful for diagnosis and follow-up.

LNP-CpG ODN-adjuvanted varicella-zoster virus glycoprotein E induced comparable levels of immunity with Shingrix^(TM) in VZV-primed mice

Latent varicella-zoster virus(VZV)may be reactivated to cause herpes zoster,which affects one in three people during their lifetime.The currently available subunit vaccine Shingrix^(TM) is superior to the attenuated vaccine Zostavax®in terms of both safety and efficacy,but the supply of its key adjuvant component QS21 is limited.With ionizable lipid nanoparticles(LNPs)that were recently approved by the FDA for COVID-19 mRNA vaccines as carriers,and oligodeoxynucleotides containing CpG motifs(CpG ODNs)approved by the FDA for a subunit hepatitis B vaccine as immunostimulators,we developed a LNP vaccine encapsulating VZV-glycoprotein E(gE)and CpG ODN,and compared its immunogenicity with Shingrix^(TM) in C57BL/6J mice.The results showed that the LNP vaccine induced comparable levels of gE-specific IgG antibodies to Shingrix^(TM) as determined by enzymelinked immunosorbent assay(ELISA).Most importantly,the LNP vaccine induced comparable levels of cellmediated immunity(CMI)that plays decisive roles in the efficacy of zoster vaccines to Shingrix^(TM) in a VZVprimed mouse model that was adopted for preclinical studies of Shingrix^(TM) .Number of IL-2 and IFN-γsecreting splenocytes and proportion of T helper 1(Th1)cytokine-expressing CD4^(+)T cells in LNP-CpG-adjuvanted VZV-gE vaccinated mice were similar to that of Shingrix^(TM) boosted mice.All of the components in this LNP vaccine can be artificially and economically synthesized in large quantities,indicating the potential of LNP-CpGadjuvanted VZV-gE as a more cost-effective zoster vaccine.

Recurrent herpes zoster in a rheumatoid arthritis patient treated with tofacitinib: A case report and review of the literature

BACKGROUND Tofacitinib is an oral Janus kinase(JAK)inhibitor that is currently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis(RA).Varicella zoster virus reactivation leading to herpes zoster(HZ)is an adverse effect of this drug;however,recurrent HZ at the same site is a rare clinical condition.CASE SUMMARY A 70-year-old female RA patient had undergone 1-year of tofacitinib treatment(10 mg daily).About 1 mo after initiation of oral tofacitinib,she developed blisters on the left flank and abdomen and was diagnosed with HZ;antiviral therapy with acyclovir was resolutory.However,5 d prior to presentation at our hospital,erythema and blisters with severe pain recurred at the same site.Small clustered blisters and bullous were visible on the left lumbar abdomen and perineum,with a pain score of 8(visual analogue scale).Antiviral,nutritional supplement,analgesic and other treatments led to healing but over an atypically long period(approximately 26 d,vs approximately 1 wk).HZ is a common and serious adverse reaction of JAK inhibitors,but it rarely recurs.Our patient’s experience of HZ recurrence at the same site,with a wider affected area,more severe pain and longer healing period,is inconsistent with previous reports.CONCLUSION Same-anatomical site HZ recurrence may occur during oral tofacitinib treatment,with more severe clinical manifestations than in the initial occurrence.

Herpes zoster internuclear ophthalmoplegia

Internuclear ophthalmoplegia(INO)is caused by a lesion in the medial longitudinal fasciculus.Patients with INO are usually asymptomatic but may have diplopia and oscillopsia.The most common causes of INO are ischemia and demyelination.Occurrence of INO due to infectious etiologies like tuberculosis,AIDS,brucellosis,cysticercosis and syphilis is well known.However,clinical presentation of INO associated with herpes zoster is very rare.The possible pathogenic mechanism for varicella zoster virus(VZV)induced INO could be demyelination or microinfarction in the brainstem.In the present study,a case of 56 years old male with double vision,with a recent history of herpes zoster,has been reported.Clinical examination revealed right INO.VZV IgM antibodies were positive and patient recovered fully after treatment with acyclovir and steroids.