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 ...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.展开更多
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 c...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.展开更多
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 pr...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.展开更多
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 cel...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.展开更多
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. VZ...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.展开更多
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 patie...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.展开更多
Objective To analyze the clinic characteristics of varicella zoster myocarditis and to determine the diagnostic value of serum cardiac troponin I (cTnI ) on the disease. Methods Information of 58 hospitalized pati...Objective To analyze the clinic characteristics of varicella zoster myocarditis and to determine the diagnostic value of serum cardiac troponin I (cTnI ) on the disease. Methods Information of 58 hospitalized patients with varicella zoster was collected, and the incidence of varicella zoster myocarditis and clinic characteristics (ECG, cTnI, age and sex distribution, etc. ) were analyzed respectively. Results It was found that 36.2% of the patients developed myocarditis. The old and female persons were much more susceptible to varicella zoster myocarditis. All patients had responsive ECG manifestations, and the abnormal ST T changes were more common than other ECG abnormalities. CTnI remained higher than normal and had significant diagnostic value. Most of the patients had good prognosis, only a few patients lasted a long time and even progressed into cardiomyopathy. Nearly all the patients came to see dermatologists when they felt ill initially. That would lead to more misdiagnosis. Conclusion Infection of varicella zoster can complicate myocarditis, we must pay more attention to the patients who suffer from varicella zoster especially in the aged and female; cTnI is an important and effective index for diagnosis of varicella zoster myocarditis.展开更多
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 adul...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.展开更多
Even though varicella is rare in pregnancy, the disease can lead occasionally to disastrous illnesses for both the mother and her neonate. By contrast, normal zoster is not associated with special problems during preg...Even though varicella is rare in pregnancy, the disease can lead occasionally to disastrous illnesses for both the mother and her neonate. By contrast, normal zoster is not associated with special problems during pregnancy and peri- natal period. Pregnant women, who contract varicella, are at risk of varicella pneumonia which must be regarded as medical emergency. At any stage during pregnancy, chickenpox may cause intrauterine infection. The consequences for the fetus depend on the time of maternal disease. During the first two trimesters, maternal varicella may result in congenital varicella syndrome which may occur in nearly 2%. Typical symptoms are skin lesions in dermatomal distribution, neurological defects, eye diseases, and skeletal anomalies. Maternal infection near term is associated with a substantial risk of intrauterine acquired neonatal chickenpox in the neonate. If the mother develops varicella rash between day 4 (5) ante partum and day 2 post partum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. The present paper reviews the clinical consequences and the currently available concepts of prevention, diagnosis, and therapy of varicella-zoster virus infections during pregnancy.展开更多
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 fou...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.展开更多
In Japan, herpes zoster is not monitored officially or nationwide. Recently, the databases of all electronic medical claims nationwide (NDBEMC) have been available for research. We use NDBEMC from April 2011 to March ...In Japan, herpes zoster is not monitored officially or nationwide. Recently, the databases of all electronic medical claims nationwide (NDBEMC) have been available for research. We use NDBEMC from April 2011 to March 2015. To evaluate the effects of initiation of routine immunization for varicella in children, we regressed the number of herpes zoster patients on the dummy variable for the routine immunization for varicella in children with and without a linear time trend. The estimated coefficient for the routine immunization for varicella was 0.5157 and its p-value was 0.001. However, if the time trend was added as an explanatory variable, the estimated coefficient for the routine immunization for varicella changed to be -0.039 and its p-value was 0.384. It means that the routine immunization for varicella was 7.8% higher after introduction than before. However, it was presumed to reflect such an upward trend.展开更多
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 immunologica...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.展开更多
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...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.展开更多
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 reactivati...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.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
基金supported by the Fujian Technological Innovation Platform Fund(2014Y2101)the Xiamen City Municipal Platform Fund(3502Z201410045,3502Z20131001)
文摘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.
文摘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.
基金This project was supported by a grant from NationalNatural Science Foundation of China (No 39770 35 5
文摘Objective To analyze the clinic characteristics of varicella zoster myocarditis and to determine the diagnostic value of serum cardiac troponin I (cTnI ) on the disease. Methods Information of 58 hospitalized patients with varicella zoster was collected, and the incidence of varicella zoster myocarditis and clinic characteristics (ECG, cTnI, age and sex distribution, etc. ) were analyzed respectively. Results It was found that 36.2% of the patients developed myocarditis. The old and female persons were much more susceptible to varicella zoster myocarditis. All patients had responsive ECG manifestations, and the abnormal ST T changes were more common than other ECG abnormalities. CTnI remained higher than normal and had significant diagnostic value. Most of the patients had good prognosis, only a few patients lasted a long time and even progressed into cardiomyopathy. Nearly all the patients came to see dermatologists when they felt ill initially. That would lead to more misdiagnosis. Conclusion Infection of varicella zoster can complicate myocarditis, we must pay more attention to the patients who suffer from varicella zoster especially in the aged and female; cTnI is an important and effective index for diagnosis of varicella zoster myocarditis.
文摘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.
文摘Even though varicella is rare in pregnancy, the disease can lead occasionally to disastrous illnesses for both the mother and her neonate. By contrast, normal zoster is not associated with special problems during pregnancy and peri- natal period. Pregnant women, who contract varicella, are at risk of varicella pneumonia which must be regarded as medical emergency. At any stage during pregnancy, chickenpox may cause intrauterine infection. The consequences for the fetus depend on the time of maternal disease. During the first two trimesters, maternal varicella may result in congenital varicella syndrome which may occur in nearly 2%. Typical symptoms are skin lesions in dermatomal distribution, neurological defects, eye diseases, and skeletal anomalies. Maternal infection near term is associated with a substantial risk of intrauterine acquired neonatal chickenpox in the neonate. If the mother develops varicella rash between day 4 (5) ante partum and day 2 post partum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. The present paper reviews the clinical consequences and the currently available concepts of prevention, diagnosis, and therapy of varicella-zoster virus infections during pregnancy.
文摘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.
文摘In Japan, herpes zoster is not monitored officially or nationwide. Recently, the databases of all electronic medical claims nationwide (NDBEMC) have been available for research. We use NDBEMC from April 2011 to March 2015. To evaluate the effects of initiation of routine immunization for varicella in children, we regressed the number of herpes zoster patients on the dummy variable for the routine immunization for varicella in children with and without a linear time trend. The estimated coefficient for the routine immunization for varicella was 0.5157 and its p-value was 0.001. However, if the time trend was added as an explanatory variable, the estimated coefficient for the routine immunization for varicella changed to be -0.039 and its p-value was 0.384. It means that the routine immunization for varicella was 7.8% higher after introduction than before. However, it was presumed to reflect such an upward trend.
文摘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.
文摘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.
基金Supported by the Doctoral Startup Fund of Affiliated Hospital of Weifang Medical University,No.2021BKQ01.
文摘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.
