Serologic and Virus-Isolation Studies of Patients with Varicella or Herpes-Zoster Infection

Gold, E. Richard

doi:10.1056/nejm196601272740403

Cited by 154 publications

(49 citation statements)

References 7 publications

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“…The alternative diagnosis of herpes zoster encephalitis was considered unlikely in view of the course of events. Mild CSF pleocytosis, as present in this case, has been reported in patients with only cutaneous zoster (Gold, 1966).…”

Section: Introductionsupporting

confidence: 71%

Interaction between carbamazepine and dextropropoxyphene

Huang

Chin

et al. 1986

Postgraduate Medical Journal

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Section: Introductionsupporting

confidence: 71%

Interaction between carbamazepine and dextropropoxyphene

Huang

Chin

et al. 1986

Postgraduate Medical Journal

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“…Studies of animal models and human sensory ganglia at autopsy indicate that at least 7 VZV open reading frames, 4,21,29,40,62,63, and 66, may be transcribed (26,79,80,(101)(102)(103)(104). Presumably during latent infection there is a block in gene expression, which is overcome on reactivation (26).…”

Section: Virologymentioning

confidence: 99%

“…The crusting over of the last crop of vesicles therefore marks the end of contagion. The possible infectiousness of individuals with varicella before the vesicles develop suggests an alternative site of viral shedding at this stage, such as the respiratory tract, but this has been more difficult to identify (62,128).…”

Section: Clinical Features Of Varicella and Zostermentioning

confidence: 99%

Preventing Varicella-Zoster Disease

2005

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Varicella-zoster virus (VZV), the cause of chickenpox and shingles, is a pathogen in retreat following the introduction of mass vaccination in the United States in 1995. The live attenuated Oka vaccine, which is safe and immunogenic, gives good protection against both varicella and zoster in the short to medium term. It has undoubtedly been highly effective to date in reducing all forms of varicella, especially severe disease. However, the huge pool of latent wild-type virus in the population represents a continuing threat. Both the biology and the epidemiology of VZV disease suggest that new vaccination strategies will be required over time

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“…Unlike cold or genital sores, herpes zoster is usually a single episode affecting the entire dermatome and is associated with severe sensory symptomatology and sometimes with short or even long-lasting sensory abnormalities. Moreover, while HSV-1 and -2 reactivations are usually not associated with meningitis, herpes zoster is accompanied by cerebrospinal fluid pleocytosis in at least a third of patients (3). The site of latency for HSV-1 in PSG is ganglion cells.…”

mentioning

confidence: 99%

Spinal Cord Involvement in Uncomplicated Herpes Zoster

Steiner¹,

Steiner-Birmanns²,

Levin³

et al. 2001

Clin Diagn Lab Immunol

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We prospectively evaluated herpes zoster patients during the acute phase of the disease for central nervous system involvement. Of 24 patients with spinal zoster, 13 (54%) had spinal cord abnormality, which was asymptomatic in 12 of the 13. Age but not lack of acyclovir treatment was associated with such involvement. In all but 2, neurological involvement resolved within 6 months. Although the mechanism responsible for the neurological abnormalities is unknown, findings may support the hypothesis that zoster is associated with spread of viral infection into the spinal cord and therefore support the possibility that zoster is due to active viral replication in the ganglion.The three neurotropic herpes viruses, herpes simplex virus type 1 (HSV-1), HSV-2, and varicella-zoster virus (VZV), reside latently in peripheral sensory ganglia (PSG) and reactivate to produce recurrent mucocutaneous disease (for reviews, see references 2, 4, and 7). However, although they belong to the same family of viruses and colonize the same tissue, there are major clinical differences between the reactivation of HSV-1 and -2 and that of VZV. Unlike cold or genital sores, herpes zoster is usually a single episode affecting the entire dermatome and is associated with severe sensory symptomatology and sometimes with short or even long-lasting sensory abnormalities. Moreover, while HSV-1 and -2 reactivations are usually not associated with meningitis, herpes zoster is accompanied by cerebrospinal fluid pleocytosis in at least a third of patients (3). The site of latency for HSV-1 in PSG is ganglion cells. However, some data suggest that in addition to neurons, nonneuronal cells also harbor the latent VZV genome (1, 6). Based on these differences, several groups proposed that nonneuronal cells might give rise to reactivated VZV, leading to active viral replication, propagation of infectious viral particles throughout the ganglion, and spread of the infection via nerve axons to the entire respective dermatome and the meninges. (5). On the other hand, HSV-1 reactivation is associated with either restricted or no viral replication in the ganglion and spread of viral particles to the cutaneous distribution of a single neuron.If indeed the cause of herpes zoster is infectious viral particles that spread from the ganglion into the periphery, one might expect a similar spread orthodromically from the ganglion into the spinal cord in cases of spinal herpes zoster and into the brain stem in cranial herpes zoster. We therefore examined central nervous system (CNS) involvement in patients with uncomplicated herpes zoster.Between the years 1997 and 1999, we enrolled all patients who presented to the neurological and/or dermatological departments and outpatient clinics in our institute, within the first week of herpes zoster. Patients underwent a thorough neurological examination and were followed up for at least 6 months after the herpes zoster episode by the same neurologist at time intervals of 1 to 2 months. In all patients, diagnosis of zoster infec...

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Serologic and Virus-Isolation Studies of Patients with Varicella or Herpes-Zoster Infection

Cited by 154 publications

References 7 publications

Interaction between carbamazepine and dextropropoxyphene

Interaction between carbamazepine and dextropropoxyphene

Preventing Varicella-Zoster Disease

Spinal Cord Involvement in Uncomplicated Herpes Zoster

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