An Unusual Case of Multi-Recurrent Herpes Zoster (Hz): A Case Report

Abstract

Aims. We report a case of multi-recurrent herpes zoster in a 53-year-old Caucasian woman treated repeatedly at the Faculty Hospital Hradec Kralove, Czech Republic over the years 2009 -2011. Methods. Specific PCR methods targeting single nucleotide polymorphisms (SNPs) in open reading frames (ORF) 38, 54 and 62 were utilized to determine vaccine or wild type varicella-zoster (VZV) strains followed by SNPs analysis using two amplicons in ORF 22 and/or ORF 21/ORF 50. Additional genotyping in ORF 1, 6, 9 and 28 was subsequently performed due to the unusual results.Results. Three sets of clinical specimens from one patient (from hospital visits 2, 3 and 4) were analyzed and the presence of an unusual wild-type strain of VZV was discovered. The VZV strain isolated from the lesions bears a combination of markers characteristic both for Mosaic 2 (M2) and European 1 (E1) wild-type VZV strains.Conclusion. This is the first report of atypical wild-type VZV strain circulating currently in Czech Republic. INTRODUCTIONVaricella zoster virus (VZV) -a member of the family herpesviridae, is a highly contagious pathogen. Humans represent the only known reservoirs for VZV (ref.1 ). The virus is easily spread among people through airborne particles, droplets in exhaled air and fluid from blisters or sores. The virus can be also transmitted indirectly by contact with clothing or other items exposed to open sores.Primary VZV infection in humans results in chickenpox, which has characteristic clinical manifestations 2 . Secondary VZV infection manifests as herpes zoster (HZ), and is caused by the reactivation of dormant virus in the dorsal root ganglia following primary VZV infection. Zoster can occur at almost any age. It is more frequent in older people with its peak occurring between the age of 60-70, but is not uncommon in immunocompromised and even normal children