Varicella-zoster virus CNS disease—Viral load, clinical manifestations and sequels

Persson, Anna; Bergström, Tomas; Lindh, Magnus; Namvar, Lili; Studahl, Marie

doi:10.1016/j.jcv.2009.07.014

Cited by 129 publications

(129 citation statements)

References 19 publications

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“…Several studies confirmed that the HSV DNA load can be low in CSF in the case of encephalitis (15)(16)(17)(18)(19)(20). The VZV DNA load in CSF can also be low (15), especially in the case of VZV-associated vasculopathy (22), meningitis (40,41), and encephalitis (21), leading to the recommendation of combining the titration of VZV antibodies in CSF with the direct detection of viral DNA (3,42). Few of the assays published in the literature (10) have been tested for LoD estimation, and only one met the criterion of 200 copies/ml for HSV in CSF specimens (43); another one exhibited a correct sensitivity but was validated for cutaneous and mucous swabs only (44).…”

Section: Discussionmentioning

confidence: 93%

“…The level of analytical sensitivity for detecting HSV and VZV DNA in CSF specimens is critical. The lack of sensitivity of most of the HSV DNA assays tested during an international external quality assessment performed more than 10 years ago conducted by Schloss et al recommends that the analytical sensitivity of NAT for the diagnosis of HSV encephalitis should be close to 200 genome copies/ml (22). Several studies confirmed that the HSV DNA load can be low in CSF in the case of encephalitis (15)(16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

“…As low viral loads (Ͻ500 copies/ml) are not infrequent in CSF of patients suffering encephalitis associated with HSV (15)(16)(17)(18)(19)(20), it was recommended to reach a sensitivity of at least 200 copies/ml for the detection of this agent in CSF (21). The same need for sensitive tests is found with encephalitis associated with VZV (15,22). The recently commercialized BD Max system (Becton Dickinson, Pont-de-Claix, France) combines the extraction and amplification steps on the same instrument, shortening the hands-on time and allowing its use in emergency molecular diagnostic testing.…”

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confidence: 99%

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Development and Validation of a Laboratory-Developed Multiplex Real-Time PCR Assay on the BD Max System for Detection of Herpes Simplex Virus and Varicella-Zoster Virus DNA in Various Clinical Specimens

et al. 2015

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A multiplex real-time PCR (quantitative PCR [qPCR]) assay detecting herpes simplex virus (HSV) and varicella-zoster virus (VZV)DNAH erpes simplex viruses 1 and 2 (HSV-1 and -2, respectively) and varicella-zoster virus (VZV) are human double-stranded DNA viruses belonging to the Herpesviridae family. In immunocompetent hosts, benign vesicular eruption of the skin and mucosa occurs during either the primary infection or reactivation episodes (1). However, life-threatening manifestations, mainly related to virus neurovirulence, can be observed (2), HSV-1 and VZV being the first and second most common causes of viral encephalitis, respectively (3, 4). These viruses are associated with mortality and morbidity, especially when treatment with acyclovir is delayed (5). HSV-2 is more likely responsible for meningitis (1). HSV-2 and VZV are also implicated in neonatal infections (1,6,7).Due to similarities in the clinical presentations of the diseases caused by these 3 herpesviruses and other pathogens, virological testing is often needed. Accurate and specific diagnosis is of special importance in cases of severe infection or in infection occurring in immunosuppressed patients who can present atypical clinical pictures (8). In replacement of cell culture and immune detection of viral antigens, molecular assays are currently the main tool used for the virological diagnosis of infections related to HSV and VZV. This trend is due to the multiple advantages of nucleic acid testing (NAT), including the rapid availability of results, its adaptation to a wide diversity of clinical specimens, the capacity for automation, and, mostly, its high sensitivity and specificity. Several FDA-approved or CE-marked in vitro diagnostic (IVD) kits are available for detecting these viruses in various specimens (9-11). However, all of them propose separate detection for HSV and VZV DNA, and only a few multiplex assays including both agents have been published as laboratory-developed tests (LDTs) (10, 12).Although detection of viral DNA is the gold standard for the virological diagnosis of neurological severe infections (3), to date, no commercial fully automated PCR assay detecting both HSV and VZV is available. However, an FDA-approved assay for HSV detection in cerebrospinal fluid (CSF) was recently validated for clinical use (13,14). As low viral loads (Ͻ500 copies/ml) are not infrequent in CSF of patients suffering encephalitis associated with , it was recommended to reach a sensitivity of at least 200 copies/ml for the detection of this agent in CSF (21). The same need for sensitive tests is found with encephalitis associated with VZV (15, 22). The recently commercialized BD Max system (Becton Dickinson, Pont-de-Claix, France) combines the extraction and amplification steps on the same instrument, shortening the hands-on time and allowing its use in emergency molecular diagnostic testing. Dedicated analyte kits (23-26) but also master mix from other companies (27) and laboratory-developed methods (28) can be

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Development and Validation of a Laboratory-Developed Multiplex Real-Time PCR Assay on the BD Max System for Detection of Herpes Simplex Virus and Varicella-Zoster Virus DNA in Various Clinical Specimens

et al. 2015

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“…This risk increases by more than 15-fold for adults [2]. General symptoms and skin lesions are more problematic and complications (e.g., pneumonia, encephalitis and hepatitis) are more often fatal in adults and adolescents [3,4]. in 2012 (Qazvin province, Iran).…”

Section: Introductionmentioning

confidence: 99%

Seroepidemiology of Varicella and value of self-reported history of Varicella infection in Iranian medical students

Allami¹,

Mohammadi²,

Najar³

2014

International Journal of Occupational Medicine and Environmental Health

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Objectives: We conducted this study to assess the seroprevalence of Varicella zoster virus (VZV) antibodies in a group of Iranian medical sciences students that were at risk of Varicella and the value of self-reported history as a predictor of immunity. Material and Methods: 255 medical, nursing and obstetrics students who had not entered as a student or worked in a hospital from 3 different schools were enrolled in the study in 2012 (Qazvin province, Iran). Demographics and other information as well as the history of Varicella were obtained through a self-administered questionnaire. Blood samples were collected to determine the Varicella IgG levels via an enzyme-linked immunosorbent assay. A statistical analysis was performed by calculating prevalences and their 95% confidence intervals. Sensitivity, specificity, positive and negative predictive values, Cohen's kappa and positive and negative likelihood ratios of recalled history were determined. p < 0.05 was considered statistically significant. Results: The mean age of participants was 21.3±4.3 years. Seropositivity rate was 74.5%. The relationships between marital status, number of family members, and acquired VZV history with immunity against the virus were statistically significant. The overall rate of reported history was 57%. The positive and negative predictive values of self-reported history of Varicella were 91% and 47.3%, respectively. Conclusions: Immunization of students of Iranian medical sciences seems logical in the near future. Also, they should be tested for Varicella immunity regardless of the history of previous infection.

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“…The virus may then reactivate at a later stage from one or more ganglia to cause herpes zoster, affecting the corresponding dermatomes (2). The virus may also cause various neurological complications, such as facial palsy, encephalitis, meningitis, and cerebral vasculitis (3)(4)(5)(6)(7)(8).…”

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confidence: 99%

Recombination of Globally Circulating Varicella-Zoster Virus

Norberg

Depledge²,

Kundu³

et al. 2015

J Virol

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Varicella-zoster virus (VZV) is a human herpesvirus, which during primary infection typically causes varicella (chicken pox) and establishes lifelong latency in sensory and autonomic ganglia. Later in life, the virus may reactivate to cause herpes zoster (HZ; also known as shingles). To prevent these diseases, a live-attenuated heterogeneous vaccine preparation, vOka, is used routinely in many countries worldwide. Recent studies of another alphaherpesvirus, infectious laryngotracheitis virus, demonstrate that live-attenuated vaccine strains can recombine in vivo, creating virulent progeny. These findings raised concerns about using attenuated herpesvirus vaccines under conditions that favor recombination. To investigate whether VZV may undergo recombination, which is a prerequisite for VZV vaccination to create such conditions, we here analyzed 115 complete VZV genomes. Our results demonstrate that recombination occurs frequently for VZV. It thus seems that VZV is fully capable of recombination if given the opportunity, which may have important implications for continued VZV vaccination. Although no interclade vaccinewild-type recombinant strains were found, intraclade recombinants were frequently detected in clade 2, which harbors the vaccine strains, suggesting that the vaccine strains have already been involved in recombination events, either in vivo or in vitro during passages in cell culture. Finally, previous partial and complete genomic studies have described strains that do not cluster phylogenetically to any of the five established clades. The additional VZV strains sequenced here, in combination with those previously published, have enabled us to formally define a novel sixth VZV clade. IMPORTANCEAlthough genetic recombination has been demonstrated to frequently occur for other human alphaherpesviruses, herpes simplex viruses 1 and 2, only a few ancient and isolated recent recombination events have hitherto been demonstrated for VZV. In the present study, we demonstrate that VZV also frequently undergoes genetic recombination, including strains belonging to the clade containing the vOKA strain.

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Varicella-zoster virus CNS disease—Viral load, clinical manifestations and sequels

Cited by 129 publications

References 19 publications

Development and Validation of a Laboratory-Developed Multiplex Real-Time PCR Assay on the BD Max System for Detection of Herpes Simplex Virus and Varicella-Zoster Virus DNA in Various Clinical Specimens

Development and Validation of a Laboratory-Developed Multiplex Real-Time PCR Assay on the BD Max System for Detection of Herpes Simplex Virus and Varicella-Zoster Virus DNA in Various Clinical Specimens

Seroepidemiology of Varicella and value of self-reported history of Varicella infection in Iranian medical students

Recombination of Globally Circulating Varicella-Zoster Virus

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