Complications of Varicella Zoster Virus Reactivation

Nagel, Maria A.; Gilden, Don

doi:10.1007/s11940-013-0246-5

Cited by 86 publications

(76 citation statements)

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“…Zoster is often associated with prodromal signs that predict the development of disease, 21,22 so it is feasible that prophylactic treatment could prevent chronic VZV-induced pain. To evaluate this experimentally, animals were first inoculated with PBS or 10 8 PFU of control vHG or vHPPE, followed by VZV inoculation at the same site.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2014

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“…Pain persisting within 30 days is defined as acute herpetic neuralgia, while if persisting between 30 and 120 days is defined as subacute herpetic neuralgia (14,15).…”

Section: Discussionmentioning

confidence: 99%

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

D’Amico

Russo

Ugga

et al. 2016

Quant. Imaging Med. Surg.

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Background: Trigeminal neuralgia (TN) is usually classified into two different categories: idiopathic and secondary. We have investigated the frequency of brainstem pontine lesions in patients with idiopathic TN without multiple sclerosis (MS) or stroke, and their association with herpes zoster (HZ) infection.Methods: Brain magnetic resonance imaging (MRI) studies of 28 patients with TN were retrospectively reviewed. Results:We found seven patients with clinical suspicion of HZ infection and pontine T2 hyperintense lesions, associated with nerve atrophy in one case. Fifteen patients had a neurovascular conflict (NVC) without brainstem involvement, two of them associated with trigeminal atrophy, while four patients had only volumetric reduction of the nerve. In all patients MRI findings were ipsilateral to the side of TN.Conclusions: Pontine T2 hyperintensities could be considered as a MRI sign of TN in patients without NVCs. This "trigeminal pontine sign" (TPS) is frequently found in association with herpetic infections. Methods MRI brain scans of twenty-eight patients (18F, 10M; mean age 52.8±14 years; range of age 26-80 years) with TN without MS or brainstem infarction were retrospectively reviewed by two neuroradiologists with 20 and 24 years of experience, respectively.Eighteen patients (12F, 6M; mean age 50 years; range of age 26-77 years) had idiopathic TN while ten patients (6F, 4M; mean age 50 years; range of age 34-63 years) had a clinical suspicion of a herpes zoster (HZ) infection; only four of these ten patients performed lumbar puncture that confirmed the diagnosis.In all cases a brain MRI was performed (Gyroscan Intera, 1.5 T, Philips Medical System, Best, The Netherlands), including FLAIR (TR: 8,005 ms, TE: 100 ms, TI: 2,200 ms, matrix: 256×192, slice thickness: 5 mm), Fast Spin-Echo (FSE) T1-and T2-weighted (TR: 583-4,454 ms, TE: 15-100 ms, matrix: 244×194−384×288, slice thickness: 5 mm, respectively) sequences; axial three-dimensional (3D) FSE T2 with a driven equilibrium pulse (DRIVE) sequence (TE: 250; TR: 1,500; flip angle: 90°; matrix: 256×256; slice thickness: 1×1×1 mm; FOV: 130×130) and magnetic resonance angiography (MRA) were performed to depict NVC and nerve atrophy. MRA was performed without contrast medium injection by using a 3-dimensional time-of-flight sequence (3D TOF, TE: 65 ms; TR: 6.9 ms; flip angle: 20°; matrix: 160×160; slice thickness: 1.40 mm; FOV: 175×200 mm). Multi planar reformation (MPR) and maximum intensity projection (MIP) reconstructions were subsequently analyzed.We evaluated the presence of brainstem lesions and their correlation with the side of the pain and the TN category. ResultsSeven patients with HZ infection showed hyperintense pontine areas on turbo spin echo (TSE) T2-weighted and FLAIR images, which we called "trigeminal pontine sign" (TPS), all of them without a NVC. Their data were summarized in Table 1. MRI was always consistent with the side of the pain. These lesions had a linear appearance, involving the pathway from the trigeminal root entry zone (...

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“…Development of herpes zoster due to reactivation of latent varicella infection may be seen due to long-term consequences. [4] Probable case definition used in Chicken Pox outbreak investigation was defined as an acute illness with diffuse (generalized) maculopapulovesicular rash, AND lack of laboratory confirmation, AND Lack of epidemiologic linkage to another probable or confirmed case. Confirmed case definition included an acute illness with diffuse (generalized) maculopapulovesicular rash, AND epidemiologic linkage to another probable or confirmed case, OR laboratory confirmation by VZV IgM & IgG ELISA from blood samples.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Report on Outbreak Investigation of Chicken Pox in Muzaffarpur District, Bihar, India

Mishra¹

2017

JCTR

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Abstract:Chicken pox or varicella is an acute infectious disease of childhood caused by varicella-zoster virus (VZV), belonging to the family Herpesviridae. Outbreaks of Chicken Pox were reported in 10 blocks in Muzaffarpur district in Bihar from 16 Jan 2016 till 7 Feb 2016. Outbreak investigation was done in 3 blocks in the district to identify the reasons of outbreak and to suggest remedial measures for its control. Discussion with the District authorities and medical and paramedical staff was done to know the background information of the affected areas, genesis of outbreak, investigations carried out so far and control measures undertaken, visit to the affected areas was done and environmental investigation, knowledge, attitude & practices of the community were also analyzed as per pre-planned questionnaire. Total 263 cases and 2 deaths due to Chicken Pox have been reported in Muzaffarpur from 10 blocks from Jan 2016 till Feb 7 2016. The disease afflicted almost all the age group but the incidence was more in the age group 1-14 years. Males were more affected than females in Block Mushahri and Meenapur while males and females are equally affected in Block Kurhani. The most common clinical manifestations observed were rash (100%), fever (88%) and headache (24%). The rash was generalized in all of the cases, and the first site was the trunk in the majority (60%) followed by face (20%) of the patients. Majority (54%) of the patients presented 51-100 lesions followed by 25-50 lesions (52%). The history of contact with a case of chickenpox was available in all the patients while none of them gave a history of vaccination against VZV. Majority of the cases recovered spontaneously without any major complications. The area was overpopulated with residents living in poorly structured houses. Majority were living in a hut with entire family with poor ventilation facilities, which led to the spread of the virus. Majority of the affected population were illiterate (54%) and unaware of the cause of the disease. The Health Workers viz: ASHAs and ANMs could play an important role in prevention of outbreak.

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Complications of Varicella Zoster Virus Reactivation

Cited by 86 publications

References 100 publications

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

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

Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia?

Epidemiological Report on Outbreak Investigation of Chicken Pox in Muzaffarpur District, Bihar, India

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