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Hirota A, Shoji J, Inada N, Adachi R, Tonozuka Y, Yamagami S. Rapid detection and diagnosis of herpetic keratitis using quantitative microfluidic polymerase chain reaction system for herpes simplex and varicella-zoster virus DNA: a case series. BMC Ophthalmol 2023; 23:177. [PMID: 37098507 PMCID: PMC10127024 DOI: 10.1186/s12886-023-02938-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/22/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND A microfluidic real-time polymerase chain reaction (PCR) system can rapidly detect the viral DNA in specimens. Detection of herpes simplex virus (HSV) and varicella-zoster virus (VZV) DNA in tears is a useful diagnostic tool for herpes simplex virus keratitis (HSK) and herpes zoster ophthalmicus (HZO). METHODS In total, 20 patients were included in this cross-sectional study. Among them, 8 patients with infectious epithelial HSK and 12 patients with HZO were included in HSK and HZO groups, respectively. In addition, 8 patients with non-herpetic keratitis and 4 healthy individuals without keratitis were included in the control group. Numbers of HSV and VZV DNA copies in tears of all patients and individuals were evaluated using a microfluidic real-time PCR system. Regarding HSV/VZV DNA test, tear specimens were collected by filter paper method using Schirmer's test paper, and subsequently, DNA was extracted from the filter paper using an automated nucleic acid extractor. Afterward, quantitative PCR was performed using a microfluidic real-time PCR system. RESULTS From tear collection to real-time PCR result determination, the HSV/VZV DNA test took approximately 40 min. In the HSK group, the sensitivity and specificity of the HSV DNA tests were 100% each. The median value (range) of number of HSV DNA copies for affected eyes was 3.4 × 105 copies/μL (under a lower detection limit of 7.6). In the HZO group, the sensitivity and specificity of the VZV DNA tests were 100% each. The median value (range) of number of VZV DNA copies for affected eyes was 5.3 × 105 copies/μL (under a lower detection limit of 5.6 × 10-2). CONCLUSION In conclusion, quantitative PCR for HSV and VZV DNA in tears using a microfluidic real-time PCR system is useful for diagnosing and monitoring HSK and HZO.
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Affiliation(s)
- Akira Hirota
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Jun Shoji
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Noriko Inada
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Rumi Adachi
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yukiko Tonozuka
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Satoru Yamagami
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamichou, Itabashi-Ku, Tokyo, 173-8610, Japan.
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Dollard S, Chen MH, Lindstrom S, Marin M, Rota PA. Diagnostic and Immunologic Testing for Varicella in the Era of High-Impact Varicella Vaccination: An Evolving Problem. J Infect Dis 2022; 226:S450-S455. [PMID: 36265850 DOI: 10.1093/infdis/jiac363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The clinical presentation of varicella in unvaccinated persons, with skin vesicles and scabs, has facilitated the use of rapid diagnostic methods for confirming disease. Polymerase chain reaction (PCR) assays are the diagnostic method of choice. The sharp decline in unmodified cases of varicella due to the US varicella vaccination program has led to fewer healthcare providers being familiar with varicella presentation and an increased reliance on laboratory diagnosis to confirm suspected cases. The mild, atypical presentation of the disease in vaccinated persons (fewer skin lesions, mostly maculopapular) has made it more challenging for providers to recognize and also to collect samples to detect the virus. Nonetheless, PCR is highly sensitive and specific in confirming modified disease if adequate samples are provided. While a positive PCR result is confirmatory, interpreting a negative result can prove to be more challenging in determining whether suspected varicella is falsely negative or attributable to other causes. Enhanced education of healthcare providers is critical for adequate specimen collection from modified varicella cases. In addition, more sensitive commercial serologic assays are needed in the United States for varicella immunity testing in the vaccine era.
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Affiliation(s)
- Sheila Dollard
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min-Hsin Chen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen Lindstrom
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Nath P, Kabir MA, Doust SK, Ray A. Diagnosis of Herpes Simplex Virus: Laboratory and Point-of-Care Techniques. Infect Dis Rep 2021; 13:518-539. [PMID: 34199547 PMCID: PMC8293188 DOI: 10.3390/idr13020049] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 02/04/2023] Open
Abstract
Herpes is a widespread viral infection caused by the herpes simplex virus (HSV) that has no permanent cure to date. There are two subtypes, HSV-1 and HSV-2, that are known to cause a variety of symptoms, ranging from acute to chronic. HSV is highly contagious and can be transmitted via any type of physical contact. Additionally, viral shedding can also happen from asymptomatic infections. Thus, early and accurate detection of HSV is needed to prevent the transmission of this infection. Herpes can be diagnosed in two ways, by either detecting the presence of the virus in lesions or the antibodies in the blood. Different detection techniques are available based on both laboratory and point of care (POC) devices. Laboratory techniques include different biochemical assays, microscopy, and nucleic acid amplification. In contrast, POC techniques include microfluidics-based tests that enable on-spot testing. Here, we aim to review the different diagnostic techniques, both laboratory-based and POC, their limits of detection, sensitivity, and specificity, as well as their advantages and disadvantages.
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Affiliation(s)
| | | | | | - Aniruddha Ray
- Department of Physics and Astronomy, University of Toledo, Toledo, OH 43606, USA; (P.N.); (M.A.K.); (S.K.D.)
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4
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Herpes Virus Infections Other than Cytomegalovirus in the Recipients of Hematopoietic Stem Cell Transplantation. Infect Dis Clin North Am 2019; 33:467-484. [PMID: 31005137 DOI: 10.1016/j.idc.2019.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This review discusses the epidemiologic and clinical aspects of herpes viruses other than cytomegalovirus in patients who have undergone hematopoietic stem cell transplantation.
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5
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Wanat KA, Dominguez AR, Carter Z, Legua P, Bustamante B, Micheletti RG. Bedside diagnostics in dermatology: Viral, bacterial, and fungal infections. J Am Acad Dermatol 2017; 77:197-218. [PMID: 28711082 DOI: 10.1016/j.jaad.2016.06.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/29/2016] [Accepted: 06/02/2016] [Indexed: 02/08/2023]
Abstract
Viral, bacterial, and fungal infections are frequently encountered in clinical practice, resulting in numerous cutaneous manifestations. Although diagnosis of these infections has changed over time because of technological advancements, such as polymerase chain reaction, bedside diagnostic techniques still play an important role in diagnosis and management, enabling rapid and low-cost diagnosis and implementation of appropriate therapies. This 2-part article will review both common and infrequent uses of bedside diagnostic techniques that dermatologists can incorporate into daily practice. This article examines the utility of bedside tests for the diagnosis of viral, bacterial, and fungal infections. The second article in this series reviews the use of bedside diagnostics for parasitic and noninfectious disorders.
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Affiliation(s)
- Karolyn A Wanat
- Department of Dermatology, Pathology, and Infectious Diseases, University of Iowa, Iowa City, Iowa
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas; Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Zachary Carter
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Pedro Legua
- Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Beatriz Bustamante
- Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru
| | - Robert G Micheletti
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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6
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Werner RN, Nikkels AF, Marinović B, Schäfer M, Czarnecka-Operacz M, Agius AM, Bata-Csörgő Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A. European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis. J Eur Acad Dermatol Venereol 2017; 31:9-19. [PMID: 27804172 DOI: 10.1111/jdv.13995] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/23/2016] [Indexed: 12/15/2022]
Abstract
Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction of the incidence of postherpetic neuralgia and other complications. The guideline development followed a structured and predefined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this first part of the guideline, diagnostic means have been evaluated. The expert panel formally consented recommendations for the management of patients with (suspected) HZ, referring to the assessment of HZ patients, considering various specific clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.
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Affiliation(s)
- R N Werner
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - B Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Schäfer
- Department of Anesthesiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Czarnecka-Operacz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - A M Agius
- Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - J Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - G E Gross
- Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany
| | - S Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R Lapid-Gortzak
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T H Lesser
- Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK
| | - U Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - G M Verjans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - P Wutzler
- Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany
| | - C Dressler
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Erdmann
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Rosumeck
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Nast
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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7
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De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World J Virol 2016; 5:97-124. [PMID: 27563537 PMCID: PMC4981827 DOI: 10.5501/wjv.v5.i3.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/08/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
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.
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8
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Lee MH, Rostal MK, Hughes T, Sitam F, Lee CY, Japning J, Harden ME, Griffiths A, Basir M, Wolfe ND, Epstein JH, Daszak P. Macacine Herpesvirus 1 in Long-Tailed Macaques, Malaysia, 2009-2011. Emerg Infect Dis 2016; 21:1107-13. [PMID: 26080081 PMCID: PMC4480374 DOI: 10.3201/eid2107.140162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Virus shedding by 39% of wild-caught macaques creates potential occupational risk for humans. Macacine herpesvirus 1 (MaHV1; B virus) naturally infects macaques (Macaca spp.) and can cause fatal encephalitis in humans. In Peninsular Malaysia, wild macaques are abundant, and translocation is used to mitigate human–macaque conflict. Most adult macaques are infected with MaHV1, although the risk for transmission to persons who handle them during capture and translocation is unknown. We investigated MaHV1 shedding among 392 long-tailed macaques (M. fascicularis) after capture and translocation by the Department of Wildlife and National Parks in Peninsular Malaysia, during 2009–2011. For detection of MaHV1 DNA, PCR was performed on urogenital and oropharyngeal swab samples. Overall, 39% of macaques were shedding MaHV1 DNA; rates of DNA detection did not differ between sample types. This study demonstrates that MaHV1 was shed by a substantial proportion of macaques after capture and transport and suggests that persons handling macaques under these circumstances might be at risk for exposure to MaHV1.
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Abstract
Herpetic lesions most frequently occur on oral and genital areas. However, herpes simplex virus (HSV) can be a rare cause of breast infection. In few published articles, the route of transmission is predominantly from infant to mother. We report two cases about simultaneous mammary and extramammary (oral and genital) herpetic infection in nonlactating women. In both cases, HSV breast lesions were acquired by sexual contacts with partners who were asymptomatic HSV carriers. Through a review of literature, we highlight clinical signs for an early diagnosis. We also emphasize the advantage of the valacyclovir for treating this uncommon pathology.
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Affiliation(s)
- Arnaud Toussaint
- Department of Gynecology, Obstetrics and Medical Genetics, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Gynecology and Obstetrics, Riviera-Chablais Hospital, Vevey, Switzerland
| | - Colin Simonson
- Department of Gynecology, Obstetrics and Medical Genetics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Christian Valla
- Department of Gynecology and Obstetrics, Riviera-Chablais Hospital, Vevey, Switzerland
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10
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Fan F, Day S, Lu X, Tang YW. Laboratory diagnosis of HSV and varicella zoster virus infections. Future Virol 2014. [DOI: 10.2217/fvl.14.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Lee BH, Um WH, Jeon SR, Kim HG, Lee TH, Kim WJ, Kim JO, Jin SY. Herpes simplex virus duodenitis accompanying Crohn's disease. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 62:292-5. [PMID: 24262595 DOI: 10.4166/kjg.2013.62.5.292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Herpes simplex virus (HSV) is a recognized cause of gastrointestinal infection in immunodeficient patients. Although a few cases of HSV gastritis and colitis in immunocompromised patients have been reported, there are no reports of HSV duodenitis in patients with Crohn's disease (CD). A 74-year-old female was admitted with general weakness and refractory epigastric pain. She had been diagnosed with CD three years ago. Esophagogastroduodenoscopy (EGD) revealed diffuse edematous and whitish mucosa with multiple erosions in the duodenum. Considering the possibility of viral co-infection, cytomegalovirus (CMV) immunohistochemical staining, PCR, and cultures of duodenal biopsies were performed, all of which were negative with the exception of the isolation of HSV in culture. After administration of intravenous acyclovir for 1 week, follow-up EGD showed almost complete resolution of the lesions and the patient's symptoms improved. In CD patients with refractory gastro-intestinal symptoms, HSV, as well as CMV, should be considered as a possible cause of infection, so that the diagnosis of viral infection is not delayed and the appropriate antiviral treatment can be initiated.
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Affiliation(s)
- Byung Hoo Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Hsu JW, Wingard JR. Advances in the management of viral infections. Cancer Treat Res 2014; 161:157-180. [PMID: 24706224 DOI: 10.1007/978-3-319-04220-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Viral infections are common in cancer patients. The risk and severity of infection are influenced by patient, disease, treatment, and viral factors. Severe viral infections are more likely to occur in treatment regimens that are more immunosuppressive. Historically, the most frequent severe infections have been due to herpesviruses, but more recently, other pathogens, especially community respiratory and hepatitis viruses, have received increasing attention as major viral pathogens in cancer patients. Because of the new diagnostic assays and the introduction of better therapeutic options, knowledge of viral infections is important in optimizing antineoplastic therapies.
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Affiliation(s)
- Jack W Hsu
- Department of Medicine, University of Florida, 1600 SW Archer Road, PO Box 100277, Gainesville, FL, 32610, USA,
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Kobayashi T, Yagami A, Suzuki K, Ihira M, Yoshikawa T, Matsunaga K. Clinical utility of loop-mediated isothermal amplification assay for the diagnosis of common alpha herpesvirus skin infections. J Dermatol 2013; 40:1033-7. [PMID: 24303946 DOI: 10.1111/1346-8138.12325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/19/2013] [Indexed: 11/29/2022]
Abstract
Loop-mediated isothermal amplification (LAMP) is a nucleic acid amplification method with a high specificity, efficiency and speed. No reports exist regarding the usefulness of LAMP for clinically suspected skin infections caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The aim of this study was to evaluate the clinical usefulness of LAMP in the diagnosis of common cutaneous alpha herpesvirus (HSV type 1 and 2, and VZV) infections. LAMP and real-time polymerase chain reaction (PCR) were performed using swab samples collected from 106 patients with clinically suspected alpha herpesvirus skin infections. The results of LAMP performed with DNA extraction did not differ from those performed without DNA extraction. The sensitivity of LAMP tested against real-time PCR was 96% in herpes simplex, 78% in eczema herpeticum, 93% in herpes zoster and 100% in varicella. No viral DNA was detected by LAMP in all negative real-time PCR samples. Viral DNA load was significantly lower in samples with false-negative LAMP results than in the LAMP-positive samples. LAMP enables confirmation of clinically suspected cutaneous HSV and VZV infections. However, the sensitivity of LAMP is lower than real-time PCR. The accuracy of LAMP may increase if sufficient viral DNA is obtained from lesions. LAMP performed without DNA extraction remains sensitive; thus, LAMP represents a quick and economical method for the diagnosis of common alpha herpesvirus skin infections.
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Affiliation(s)
- Tsukane Kobayashi
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
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14
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Sharaf RN, Shergill AK, Odze RD, Krinsky ML, Fukami N, Jain R, Appalaneni V, Anderson MA, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Early D, Evans JA, Fanelli RD, Fisher DA, Fisher LR, Foley KQ, Hwang JH, Jue TL, Ikenberry SO, Khan KM, Lightdale J, Malpas PM, Maple JT, Pasha S, Saltzman J, Dominitz JA, Cash BD. Endoscopic mucosal tissue sampling. Gastrointest Endosc 2013; 78:216-24. [PMID: 23867371 DOI: 10.1016/j.gie.2013.04.167] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 02/07/2023]
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15
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Jazeron JF, Barbe C, Frobert E, Renois F, Talmud D, Brixi-Benmansour H, Brodard V, Andréoletti L, Diebold MD, Lévêque N. Virological diagnosis of herpes simplex virus 1 esophagitis by quantitative real-time PCR assay. J Clin Microbiol 2012; 50:948-52. [PMID: 22170921 PMCID: PMC3295176 DOI: 10.1128/jcm.05748-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/05/2011] [Indexed: 12/12/2022] Open
Abstract
Herpes simplex virus 1 (HSV-1) esophagitis diagnosis is routinely based on the endoscopic findings confirmed by histopathological examination of the esophagitis lesions. Virological diagnosis is not systematically performed and restricted to viral culture or to qualitative PCR assay from esophagitis biopsy specimens. The aim of this study was to assess the interest of quantitative real-time PCR assay in HSV-1 esophagitis diagnosis by comparing the results obtained to those of histological examination associated with immunohistochemical staining, which is considered the "gold standard." From 53 esophagitis biopsy specimens, the PCR assay detected HSV-1 in 18 of 19 histologically proven to have herpetic esophagitis and in 9 of 34 that had esophagitis related to other causes, demonstrating sensitivity, specificity, positive predictive value, and negative predictive value of 94.7%, 73%, 66.7%, and 96%, respectively. Interestingly, HSV-1 was not detected in 16 specimens without the histological aspect of esophagitis. The viral loads normalized per μg of total extracted DNA in each biopsy specimen detected positive by HSV PCR were then compared and appeared to be significantly higher in histopathologically positive herpetic esophagitis (median = 2.9 × 10(6) ± 1.1 × 10(8)) than in histopathologically negative herpetic esophagitis (median = 3.1 × 10(3) ± 6.2 × 10(3)) (P = 0.0009). Moreover, a receiver operating characteristics analysis revealed that a viral load threshold greater than 2.5 × 10(4) copies would allow an HSV-1 esophagitis diagnosis with a sensitivity and specificity of 83.3% and 100%, respectively. In conclusion, this work demonstrated that HSV quantitative PCR results for paraffin-embedded esophageal tissue was well correlated to histopathological findings for an HSV-1 esophagitis diagnosis and could be diagnostic through viral load assessment when histopathological results are missing or uncertain.
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Affiliation(s)
| | - Coralie Barbe
- Clinical Research Coordination Unit, University Hospital of Reims, Reims, France
| | - Emilie Frobert
- Virology Department, University Hospital of Lyon, Lyon, France
| | - Fanny Renois
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | - Déborah Talmud
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | | | | | - Laurent Andréoletti
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | | | - Nicolas Lévêque
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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Weisz B, Book M, Lipitz S, Katorza E, Achiron R, Grossman Z, Shrim A. Fetal outcome and amniocentesis results in pregnancies complicated by varicella infection. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:720-724. [PMID: 21749748 DOI: 10.1016/s1701-2163(16)34957-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the outcome of infants born to mothers with varicella zoster virus (VZV) infection in pregnancy who had second trimester amniocentesis for detection of placental transfer. METHODS We interviewed women who had had VZV infection in pregnancy and who underwent diagnostic amniocentesis to detect transplacental infection using both polymerase chain reaction (PCR) and cell culture methods to characterize their children's clinical and psychomotor development. RESULTS Twenty women who had a diagnosis of primary VZV during pregnancy were available for interview. The mean gestational age at which primary VZV was acquired was 11±3.5 weeks. One infant had hypospadias and developmental delay. He was born to an epileptic mother who had been treated during pregnancy with sodium valproate and clonazepam. Another infant had abnormal brainstem auditory-evoked potentials. All other infants were reported to have normal clinical and psychomotor development. CONCLUSION In cases of varicella infection during pregnancy, negative studies of amniotic fluid using PCR may contribute to decision making.
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Affiliation(s)
- Boaz Weisz
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer. Affiliated with Sackler School of Medicine, Tel-Aviv University Tel-Aviv Israel
| | - Mazal Book
- Central Virology Laboratory, Public Health Services, Ministry of Health, The Chaim Sheba Medical Center, Tel-Hashomer. Affiliated with Sackler School of Medicine, Tel-Aviv University Tel-Aviv Israel
| | - Shlomo Lipitz
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer. Affiliated with Sackler School of Medicine, Tel-Aviv University Tel-Aviv Israel
| | - Eldad Katorza
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer. Affiliated with Sackler School of Medicine, Tel-Aviv University Tel-Aviv Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer. Affiliated with Sackler School of Medicine, Tel-Aviv University Tel-Aviv Israel
| | - Zehava Grossman
- Central Virology Laboratory, Public Health Services, Ministry of Health, The Chaim Sheba Medical Center, Tel-Hashomer. Affiliated with Sackler School of Medicine, Tel-Aviv University Tel-Aviv Israel
| | - Alon Shrim
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal QC
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Schmid DS, Jumaan AO. Impact of varicella vaccine on varicella-zoster virus dynamics. Clin Microbiol Rev 2010; 23:202-17. [PMID: 20065330 PMCID: PMC2806663 DOI: 10.1128/cmr.00031-09] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The licensure and recommendation of varicella vaccine in the mid-1990s in the United States have led to dramatic declines in varicella incidence and varicella-related deaths and hospitalizations. Varicella outbreaks remain common and occur increasingly in highly vaccinated populations. Breakthrough varicella in vaccinated individuals is characteristically mild, typically with fewer lesions that frequently do not progress to a vesicular stage. As such, the laboratory diagnosis of varicella has grown increasingly important, particularly in outbreak settings. In this review the impact of varicella vaccine on varicella-zoster virus (VZV) disease, arising complications in the effective diagnosis and monitoring of VZV transmission, and the relative strengths and limitations of currently available laboratory diagnostic techniques are all addressed. Since disease symptoms often resolve in outbreak settings before suitable test specimens can be obtained, the need to develop new diagnostic approaches that rely on alternative patient samples is also discussed.
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Affiliation(s)
- D Scott Schmid
- Herpesvirus Team and National VZV Laboratory, Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Centers for Disease Control and Prevention, National Center for Immunizations and Respiratory Diseases, Division of Viral Diseases, Atlanta, Georgia 30333, USA.
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Lang PO, Belmin J, Michel JP. [Herpes zoster in old adults]. Presse Med 2008; 38:571-83. [PMID: 19028069 DOI: 10.1016/j.lpm.2008.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 05/20/2008] [Accepted: 05/26/2008] [Indexed: 11/28/2022] Open
Abstract
The varicella-zoster virus is an exclusively human herpesvirus, responsible for chickenpox. Its reactivation, after several decades, causes herpes zoster (shingles). Herpes zoster produces a rash, classically metameric, that causes acute pain and complications to elderly patients. The last, most painful, and disabling of these is postherpetic neuralgia. This neuralgia is defined as a painful syndrome lasting for more than 30 days after eruption of the rash. Today's systemic antiviral drugs can reduce the severity of the eruption, limit the pain, and diminish the incidence of postherpetic neuralgia. A recent advance in primary prevention is approval of a vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia in subjects 60 years or older.
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Affiliation(s)
- Pierre-Olivier Lang
- Département de réhabilitation et gériatrie, Faculté de médecine et Hôpitaux universitaires de Genève, CH-1226 Thônex-Genève, Suisse.
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GIBNEY MDAVIS, NAHASS GT, LEONARDI CL. Cutaneous reactions following herpes zoster infections: report of three cases and a review of the literature. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.39774.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nahassf G, Penneys N, Leonardi C. Interface dermatitis in acute varicella-zoster virus infection: demonstration of varicella-zoster virus DNA in keratinocytes by in situ
polymerase chain reaction. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-960.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ozcan A, Senol M, Saglam H, Seyhan M, Durmaz R, Aktas E, Ozerol IH. Comparison of the Tzanck test and polymerase chain reaction in the diagnosis of cutaneous herpes simplex and varicella zoster virus infections. Int J Dermatol 2008; 46:1177-9. [PMID: 17988338 DOI: 10.1111/j.1365-4632.2007.03337.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the diagnosis of herpes simplex virus (HSV) and varicella zoster virus (VZV) infections is usually made clinically, the Tzanck test, electron microscopy, viral culture, polymerase chain reaction (PCR), and serologic tests can be utilized to verify the diagnosis. METHODS We conducted a study on a total of 98 patients (77 patients with recurrent herpes simplex and 21 patients with herpes zoster) to evaluate the reliability and reproducibility of the Tzanck test in comparison with PCR. RESULTS In herpes virus infections, the general positivity rates of the Tzanck test and PCR were 61.2% and 79.6%, respectively. The difference between the positivity rates of the two tests was statistically significant. The positivity rates of the tests differed according to the type and duration of the lesions. CONCLUSIONS Although PCR was superior to the Tzanck test, the Tzanck test has also been proven to be a reliable diagnostic method, with a sensitivity of 76.9% and a specificity of 100%. We recommend the use of this easy, quick, reproducible, and inexpensive diagnostic test more often in dermatologic practice, especially in cutaneous herpes virus infections.
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Affiliation(s)
- Atilla Ozcan
- Department of Dermatology, Inonu University School of Medicine, Malatya, Turkey
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24
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Abstract
Herpes simplex esophagitis (HSE) is well documented in immunosuppressed patients. However, it is rare in the immunocompetent host. We present a case of HSE in a 21 year-old healthy lady who was admitted to our unit with dysphagia, odynophagia and chest pain. Clinical examination revealed mild epigastric tenderness and admission bloods including full blood picture, electrolytes and inflammatory markers were normal. She underwent an esophagogastroduodenoscopy (EGD) which revealed severe exudative, well-circumscribed ulcerations in her distal esophagus. Biopsies confirmed severe esophagitis with acute ulceration and subsequent polymerase chain reaction (PCR) confirmed herpes simplex virus (HSV) type 1. Subsequent assessment failed to identify an immune disorder. HSE should be suspected when faced with characteristic endoscopic findings, even if the patient is immunocompetent. When the diagnosis of HSE is confirmed, an immune deficiency should be sought.
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Affiliation(s)
- Bee Lee
- Department of Gastroenterology, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, United Kingdom.
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25
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Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJM, Wallace MS, Wassilew SW, Whitley RJ. Recommendations for the management of herpes zoster. Clin Infect Dis 2007; 44 Suppl 1:S1-26. [PMID: 17143845 DOI: 10.1086/510206] [Citation(s) in RCA: 446] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.
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Affiliation(s)
- Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA.
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RODRÍGUEZ-PEREIRA C, SUÁAREZ-PEÑARANDA J, RÍO EDEL, FORTEZA-VILA J. Cutaneous granulomatous vasculitis after herpes zoster infection showing polyarteritis nodosa-like features. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.1997.tb01094.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hill J, Roberts S. Herpes simplex virus in pregnancy: new concepts in prevention and management. Clin Perinatol 2005; 32:657-70. [PMID: 16085025 DOI: 10.1016/j.clp.2005.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases in the United States. It is estimated that 45 million adolescents and adults are infected with genital HSV. Most genital herpes infections in the United States are caused by HSV type 2 (HSV-2), and 25% to 30% of women of reproductive age have HSV-2 antibodies. What is more striking is that genital herpes is frequently under-recognized, and that only 5% to 10% of these women have a history of genital herpes. Because such a small percentage of women are aware of being infected with HSV, the risk of maternal transmission of this virus to the fetus or newborn is a significant health issue.
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Affiliation(s)
- James Hill
- Department of Obstetrics and Gynecology, Department of the Army, Womack Army Medical Center, 2817 Reilly Road MCXC, Fort Bragg, NC 28310-730, USA.
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Abstract
In general, a detailed history and examination of the patient provides sufficient information for diagnosis. The pattern, frequency, and natural history of ulcer episodes are helpful. The presence or absence of associated features and the site of oral involvement guides most physicians accurately in the diagnosis. Additional investigations, including blood tests, and occasionally the use of oral cultures or biopsy, are needed to make a definitive diagnosis. A multispecialty approach is often necessary to evaluate patients with other systemic features. Most acute oral ulcers heal spontaneously without specific therapy being necessary, but an understanding of the cause of the ulcer is reassuring to the patient and guides the clinician in management to prevent recurrent episodes of oral ulceration, or chronicity of ulcers.
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Affiliation(s)
- Alison J Bruce
- Department of Dermatology, Mayo Clinic, 200 First Street SW Rochester MN 55905, USA.
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29
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Abstract
A wide variety of both DNA and RNA viruses affect the oral cavity. When considered in conjunction with cutaneous features, careful examination of the oral mucosa and oropharynx aids the clinician in making a diagnosis. Examination of the oral cavity should be incorporated as a regular component of the dermatologic examination because diagnostic clues are readily available to assist in the evaluation of infectious processes.
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Affiliation(s)
- Bethany R Hairston
- Department of Dermatology, Mayo Graduate School of Medicine, Rochester, MN 55905, USA
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30
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Thomas SL, Wheeler JG, Hall AJ. Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. Lancet 2002; 360:678-82. [PMID: 12241874 DOI: 10.1016/s0140-6736(02)09837-9] [Citation(s) in RCA: 194] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Whether exogenous exposure to varicella-zoster-virus protects individuals with latent varicella-zoster virus infection against herpes zoster by boosting immunity is not known. To test the hypothesis that contacts with children increase exposure to varicella-zoster virus and protect latently infected adults against zoster, we did a case-control study in south London, UK. METHODS From 22 general practices, we identified patients with recently diagnosed zoster, and control individuals with no history of zoster, matched to patients by age, sex, and practice. Participants were asked about contacts with people with varicella or zoster in the past 10 years, and social and occupational contacts with children as proxies for varicella contacts. Odds ratios were estimated with conditional logistic regression. FINDINGS Data from 244 patients and 485 controls were analysed. On multivariable analysis, protection associated with contacts with a few children in the household or via childcare seemed to be largely mediated by increased access to children outside the household. Social contacts with many children outside the household and occupational contacts with ill children were associated with graded protection against zoster, with less than a fifth the risk in the most heavily exposed groups compared with the least exposed. The strength of protection diminished after controlling for known varicella contacts; the latter remained significantly protective (odds ratio 0.29 [95% CI 0.10-0.84] for those with five contacts or more). INTERPRETATION Re-exposure to varicella-zoster virus via contact with children seems to protect latently infected individuals against zoster. Reduction of childhood varicella by vaccination might lead to increased incidence of adult zoster. Vaccination of the elderly (if effective) should be considered in countries with childhood varicella vaccination programmes.
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Affiliation(s)
- Sara L Thomas
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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31
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Spray A, Glaser DA. Herpes zoster of the penis: an unusual location for a common eruption. J Am Acad Dermatol 2002; 47:S177-9. [PMID: 12140455 DOI: 10.1067/mjd.2002.108587] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Herpes zoster is an acute vesiculobullous eruption estimated to affect 10% to 20% of the population. The diagnosis usually can be based on clinical features alone, but laboratory studies may be needed for definitive diagnosis, particularly in atypical presentations.
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Affiliation(s)
- Angela Spray
- Department of Dermatology, St. Louis University School of Medicine, MO 63104, USA
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32
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Youssef R, Shaker O, Sobeih S, Mashaly H, Mostafa WZ. Detection of herpes simplex virus DNA in serum and oral secretions during acute recurrent herpes labialis. J Dermatol 2002; 29:404-10. [PMID: 12184636 DOI: 10.1111/j.1346-8138.2002.tb00294.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although herpes simplex virus (HSV) has been detected in the peripheral blood of immunocompromised patients and in neonates with disseminated disease, the extent to which the virus may be present in the blood during a localized infection in otherwise healthy patients is still unknown. Literature on patterns of HSV shedding into the oral cavity at the prodromal stage of the disease, during recurrences, and also during asymptomatic periods is still lacking. The present study aims at the detection of HSV DNA in the serum and oral secretions during acute herpes labialis using a highly sensitive technique, the polymerase chain reaction (PCR). The study included 10 patients with acute herpes labialis and five healthy controls. Using PCR, herpes simplex virus DNA was detected in the serum of seven patients (70%) and in the saliva of nine patients (90%). One of the control cases showed positive HSV DNA in the saliva (20%). There was good statistical agreement between the presence of HSV DNA in the serum and saliva. Frequency of attacks, patient's age, and gender had no statistically significant effect on the presence of the virus in serum or in saliva. It is concluded that HSV viremia during attacks of recurrent herpes simplex is more frequent than previously appreciated.
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Affiliation(s)
- Randa Youssef
- Department of Dermatology, Faculty of Medicine, Cairo University, Egypt
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33
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Lilie HM, Wassilew SW, Wolff MH. Early diagnosis of herpes zoster by polymerase chain reaction. J Eur Acad Dermatol Venereol 2002; 16:53-7. [PMID: 11952291 DOI: 10.1046/j.0926-9959.2001.00351.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Herpes zoster is a common disease caused by the varicella-zoster virus. The use of virostatic agents as early as possible is necessary in shortening zoster-associated pain. OBJECTIVES Rapid diagnosis is necessary for the optimal efficacy of antiviral therapy. The diagnosis in the early stage of infection is often difficult. METHODS In the present study skin biopsies of patients with herpes zoster and unclear skin changes were analysed by detecting viral DNA using the polymerase chain reaction (PCR) in order to amplify open reading frames (ORF) 14, 29 and 63. RESULTS Varicella-zoster virus DNA could be detected with PCR of all three ORF not only from blisters but also from erythematous skin. CONCLUSIONS PCR is the method of choice for the viral diagnosis in herpes zoster before blister eruption.
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Affiliation(s)
- H M Lilie
- Dermatology Department, Klinikum Krefeld, Germany.
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34
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Zaal MJ, Völker-Dieben HJ, Wienesen M, D'Amaro J, Kijlstra A. Longitudinal analysis of varicella-zoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus. Am J Ophthalmol 2001; 131:25-9. [PMID: 11162975 DOI: 10.1016/s0002-9394(00)00652-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Longitudinal analysis of varicella-zoster virus DNA on the ocular surface of patients with herpes zoster ophthalmicus. METHODS Clinical specimens were obtained from the bulbar conjunctival surface with a cotton-tipped swab at weekly intervals for 6 consecutive weeks from 21 patients with acute ophthalmic zoster with a skin rash duration of less than 7 days. All patients received oral valacyclovir 1000 mg three times daily for 10 days without additional corticosteroids. The swabs were analyzed by means of polymerase chain reaction for the presence of varicella-zoster virus and herpes simplex virus type 1 DNA. Conjunctival swabs were also obtained from a control group of 20 patients with cataract. RESULTS On inclusion, varicella-zoster virus DNA was present on the ocular surface of 19 of the 21 patients. Six varicella-zoster virus DNA-positive patients had no signs of ocular inflammation. All control swabs were negative for both varicella-zoster virus and herpes simplex virus DNA. The duration of varicella-zoster virus DNA detection from rash onset varied from 2 to 34 days. The number of days between the onset of herpes zoster skin rash and the latest positive varicella-zoster virus DNA test was significantly longer in patients whose age was equal to or above the median age of 66 years than in the younger patients (Mann-Whitney test: P =.0004). At 6-week follow-up, all conjunctival swabs were negative for varicella-zoster virus DNA. However, at that time, the eyes of seven patients were still inflamed. CONCLUSION The duration of varicella-zoster virus DNA shedding in herpes zoster ophthalmicus is highly variable and age dependent, and is probably related to the host immune response.
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Affiliation(s)
- M J Zaal
- Department of Ophthalmology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
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35
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Markoulatos P, Georgopoulou A, Kotsovassilis C, Karabogia-Karaphillides P, Spyrou N. Detection and typing of HSV-1, HSV-2, and VZV by a multiplex polymerase chain reaction. J Clin Lab Anal 2000. [DOI: 10.1002/1098-2825(2000)14:5<214::aid-jcla3>3.0.co;2-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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36
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Abstract
Because of its ability to produce two clinically distinct disease entities (chickenpox and shingles), varicella zoster virus (VZV) is an unusual etiologic agent. Although in the past viral exanthems were mostly only of academic interest to the practitioner, the development of antiviral agents and the newly approved varicella (OKA) vaccine have increased the clinical significance. Also, with the increasing seroprevalence of HIV infection, more patients will be stricken with zoster (at a younger age) and disseminated varicella. In this review, the history, incidence, pathogenesis, clinical manifestations, and treatment options (of VZV infection and postherpetic neuralgia) will be discussed.
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Affiliation(s)
- M L McCrary
- Section of Dermatology, Medical College of Georgia, Augusta, USA
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37
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Infections a CMV. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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38
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Mirlesse V, Magny JF, Solé Y, Jacquemard F, Forestier F, Daffos F. Infections à VZV. Formes de la femme enceinte et du nouveau-né. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80105-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Abstract
In reviewing the clinical features, diagnostic evaluations and therapies of the most common ocular viral infections we attempt to whet your appetite for attacking the numerous challenges in diagnosis and treatment of viral eye disease. The herpes viruses, HSV, VZV and CMV are the cause of significant ocular morbidity. HSV most commonly affects the cornea producing keratitis that can be recurrent and may lead to corneal clouding and neovascularisation. Manifestations can be purely infectious or immunological and treatment options must be tailored to the underlying pathophysiology. Herpes zoster ophthalmicus, caused by VZV infection of the first branch of the trigeminal nerve, produces a characteristic rash and can progress to keratitis and uveitis. HSV and VZV can cause retinitis in both immunocompetent and immunocompromised individuals. There has been a significant increase in the incidence of CMV retinitis since the beginning of the AIDS epidemic. We review the numerous new treatments, diagnostic tests and treatment strategies which have been developed in response to this potentially blinding retinal infection. Adenovirus produces an epidemic conjunctivitis and epidemic keratoconjunctivitis which are severe and extremely contagious conjunctival infections. HIV, molluscum contagiosum, EBV and rubeola also cause ocular diseases which are described.Copyright 1998 John Wiley & Sons, Ltd.
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Affiliation(s)
- DC Ritterband
- New York Medical College, New York Eye and Ear Infirmary
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40
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Nogueira ML, Oliveira AF, Araujo JG, Gallo MA, Fonseca JG, Bonjardim CA, Ferreira PC, Kroon EG. PCR-based diagnosis of a case of herpetic whitlow in an AIDS patient. Rev Inst Med Trop Sao Paulo 1998; 40:317-9. [PMID: 10030077 DOI: 10.1590/s0036-46651998000500009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Herpetic infections are common complications in AIDS patients. The clinical features could be uncommon and antiviral chemotherapy is imperative. A rapid diagnosis could prevent incorrect approaches and treatment. The polymerase chain reaction is a rapid, specific and sensible method for DNA amplification and diagnosis of infectious diseases, especially viral diseases. This approach has some advantages compared with conventional diagnostic procedures. Recently we have reported a new PCR protocol to rapid diagnosis of herpetic infections with suppression of the DNA extraction step. In this paper we present a case of herpetic whitlow with rapid diagnosis by HSV-1 specific polymerase chain reaction using the referred protocol.
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Affiliation(s)
- M L Nogueira
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Wingard JR. Recent advances in the management of viral infections. Cancer Treat Res 1998; 96:183-200. [PMID: 9711400 DOI: 10.1007/978-0-585-38152-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J R Wingard
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville 32610-0277, USA
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42
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Abstract
Herpes zoster is the clinical consequence of a late reactivation of the varicella zoster virus (VZV). It infects mainly the elderly, but pediatric cases are not uncommon. It occurs mostly in immunocompromised children, or in infancy after reactivation of latent VZV infection acquired transplacentally during intrauterine life. Rarely, herpes zoster occurs in otherwise normal children, especially following varicella during the first year of life. Clinical presentation of herpes zoster in children is identical to that of adult, with usually a benign course. The impairment of cellular and non specific immunity (Natural Killer cells) appears to have a particular role in the occurrence of herpes zoster. Treatment of the usual form comprises antiseptic measures and prevention of pruritus. In immunocompromised children, the infection is generally severe and disseminated, and can result in high rates of morbidity and mortality, thus requiring specific intravenous antiviral therapy with antiviral drugs such as acyclovir without delay. There is no single approach towards VZV infection prevention in immunocompromised hosts. Vaccination with live attenuated varicella vaccine, has proved to be efficient and safe in immunocompromised children.
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Affiliation(s)
- A Banerjee
- Service de pédiatrie générale, centre hospitalier René-Dubos, Pontoise, France
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43
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Mouly F, Mirlesse V, Méritet JF, Rozenberg F, Poissonier MH, Lebon P, Daffos F. Prenatal diagnosis of fetal varicella-zoster virus infection with polymerase chain reaction of amniotic fluid in 107 cases. Am J Obstet Gynecol 1997; 177:894-8. [PMID: 9369842 DOI: 10.1016/s0002-9378(97)70291-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Varicella, resulting from primary infection by varicella zoster virus, carries a risk of severe congenital varicella. Prenatal diagnosis is rarely applied because methods remain to be validated. STUDY DESIGN From 1989 to 1994, 107 women contracted clinical varicella before 24 weeks of pregnancy. Amniocentesis was performed in all cases, with simultaneous fetal blood sampling in 82 cases. Virus was detected in amniotic fluid by cell culture inoculation and polymerase chain reaction. Fetal blood was tested for anti-varicella zoster virus immunoglobulin M. RESULTS Of the 107 amniotic fluid samples tested, nine of 107 (8.4%) were positive by polymerase chain reaction, but only two of these (1.8%) were positive in cell culture; none of the blood samples from infected fetuses were positive for specific anti-varicella zoster virus immunoglobulin M. The outcome of 99 pregnancies was fully documented. CONCLUSION The risk of transplacental passage before 24 weeks of pregnancy was 8.4% in our series. The risk of congenital varicella is 3 in 107 (2.8%) and that of isolated postnatal varicella zoster infection is 3 in 78 (3.8%). Polymerase chain reaction is more sensitive than cell culture for the detection of varicella zoster virus in amniotic fluid.
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Affiliation(s)
- F Mouly
- Laboratoire de Recherche sur les Infections Virales, Hôpital Saint Vincent de Paul, Université René Descartes, Paris, France
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44
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Tremblay C, Coutlée F, Weiss J, Guibinga GH, Hankins C, Lapointe N. Evaluation of a non-isotopic polymerase chain reaction assay for detection in clinical specimens of herpes simplex virus type 2 DNA. Canadian Women's HIV Study Group. CLINICAL AND DIAGNOSTIC VIROLOGY 1997; 8:53-62. [PMID: 9248658 DOI: 10.1016/s0928-0197(97)00012-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND PCR assays for detection of herpes simplex virus DNA sequences in clinical specimens are more sensitive than cell culture. OBJECTIVE A non-isotopic PCR assay (glycoprotein B HSV-2 assay, Roche Molecular Systems) for detection of HSV-2 DNA sequences was evaluated on 234 clinical specimens. STUDY DESIGN A total of 125 patients (73 women, 40 men, 12 unknown) provided 162 samples contained in viral transport medium. Samples were first inoculated in cell culture, centrifuged at 12,000 x g, lyzed and kept frozen. A total of 77 women provided 42 cervicovaginal lavages and 30 vaginal tampons that were lyzed, tested with two isotopic HSV-2 PCR assays and kept frozen. All these samples were subsequently thawed and amplified with the glycoprotein B HSV-2 assay using generic primers for HSV glycoprotein B gene. Amplicons were captured on microplates with a HSV-2-specific probe and were detected with avidin-peroxidase and substrate. RESULTS Of the 162 samples submitted to viral culture, HSV-2 was isolated from 73 while 89 did not contain HSV-2. All the 73 specimens with culture-proven HSV-2 infections tested positive with glycoprotein B HSV-2 assay (sensitivity of 100%). Herpesviruses other than HSV-2 were isolated from 34 samples that were negative with glycoprotein B HSV-2 assay. Two culture-negative samples tested positive in the glycoprotein B HSV-2 assay (specificity of 98.7%). The latter samples could not be retested in confirmatory isotopic HSV-2 PCR tests. HSV-2 DNA sequences could also be detected directly in cervical lavages or vaginal tampons from 13 women with the glycoprotein B HSV-2 assay. CONCLUSION Detection and typing of HSV-2 in clinical samples, including those collected in viral transport medium, can be accomplished with PCR assays using the AMPLICOR format.
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Affiliation(s)
- C Tremblay
- Département de Microbiologie-Immunologie, Université de Montréal, Québec, Canada
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45
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Christian CW, Singer ML, Crawford JE, Durbin D. Perianal herpes zoster presenting as suspected child abuse. Pediatrics 1997; 99:608-10. [PMID: 9093310 DOI: 10.1542/peds.99.4.608] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- C W Christian
- University of Pennsylvania School of Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia 19104, USA
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46
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Safrin S, Shaw H, Bolan G, Cuan J, Chiang CS. Comparison of virus culture and the polymerase chain reaction for diagnosis of mucocutaneous herpes simplex virus infection. Sex Transm Dis 1997; 24:176-80. [PMID: 9132986 DOI: 10.1097/00007435-199703000-00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of mucocutaneous herpes simplex virus (HSV) is hampered by suboptimal sensitivity of virus culture and atypical clinical morphology. GOALS To compare the diagnostic usefulness of the polymerase chain reaction (PCR) and virus culture. STUDY DESIGN Consecutive samples from 246 patients at an urban sexually transmitted diseases clinic were tested for HSV by both PCR and virus culture. RESULTS Only 59% of HSV-positive samples were correctly diagnosed by the clinician; 11% had an atypical appearance. HSV-positive lesions were more often vesiculoulcerative or crusted than HSV-negative lesions, and of shorter median duration. Thirty-one samples were PCR positive and virus culture negative; these were often from crusted or older lesions. However, PCR was negative in 27 instances in which HSV was diagnosed clinically, of which 2 were vesicular and 15 ulcerative. CONCLUSIONS HSV PCR is more rapid and sensitive than virus culture for diagnosis of mucocutaneous lesions. The data suggesting that PCR may be suboptimally sensitive need to be further investigated.
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Affiliation(s)
- S Safrin
- Department of Medicine, University of California, San Francisco, USA
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47
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Baselga E, Drolet BA, Segura AD, Leonardi CL, Esterly NB. Dermatomal lichenoid chronic graft-vs-host disease following varicella-zoster infection despite absence of viral genome. J Cutan Pathol 1996; 23:576-81. [PMID: 9001991 DOI: 10.1111/j.1600-0560.1996.tb01453.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Localized cutaneous graft-versus-host disease (GVHD) following a dermatomal distribution or in a pattern of Blaschko's lines. Some authors have postulated that dermatomal GVHD is triggered by a varicella-zoster virus infection, although in reported cases, there was no history of a preceding herpes zoster. We describe a case of GVHD localized to the exact dermatome of a culture-proven varicella-zoster virus infection. PCR analysis failed to detect persistence of viral genome in the affected skin.
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Affiliation(s)
- E Baselga
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, USA
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48
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Abstract
A large body of molecular biologic research has begun to clarify some basic aspects of viral latency and reactivation. The clinical definition of herpes simplex virus infection is expanding, with the recognition that the disease is largely asymptomatic and that most transmission occurs during periods of asymptomatic viral shedding. With this awareness, serologic diagnosis has become increasingly important. New treatment modalities are now available, and other promising treatments are in development.
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Affiliation(s)
- F A Pereira
- Department of Dermatology, Mount Sinai Medical Center, NY 11355-4163, USA
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49
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Baron JM, Rübben A, Grussendorf-Conen EI. Evaluation of a new general primer pair for rapid detection and differentiation of HSV-1, HSV-2, and VZV by polymerase chain reaction. J Med Virol 1996; 49:279-82. [PMID: 8877759 DOI: 10.1002/(sici)1096-9071(199608)49:4<279::aid-jmv4>3.0.co;2-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The polymerase chain reaction (PCR) enables rapid and sensitive detection of VZV and HSV DNA and its efficiency depends mainly on the choice of the primers. Primers should hybridize to conserved DNA sequences within the viral genomes in order to avoid unreliable amplification due to DNA sequence variation between different strains. The aim of the study was to design and to evaluate a general primer pair which permits fast and reliable detection of HSV and VZV. The genes UL 15 of HSV and UL 42 of VZV share the highest degree of homology within the two genomes. We designed a primer pair (GPHV-RU) which hybridizes to these genes. The genetic variability of amplified sequences from clinical specimens was analyzed by restriction enzyme cleavage analysis and by temperature gradient SSCP analysis (TG-SSCP). PCR with GPHV-RU amplified viral sequences from all analyzed specimens (25 x VZV, 10 x HSV-1, 5 x HSV-2) obtained from patients with clinical evidence of HSV or VZV infection. Restriction enzyme cleavage analysis with Hpa II further permitted reliable distinction between VZV, HSV-1, and HSV-2. Analysis of the heterogeneity of the amplified sequences by restriction enzyme cleavage and by TG-SSCP demonstrated no variability between the analyzed clinical specimens of VZ and of HSV-2 and only one differing TG-SSCP-pattern within the HSV-1 isolates. The results suggest that detection of HSV and VZV using the new primer pair GPHV-RU should give reliable results as the amplified sequences show little genetic variability within clinical isolates of HSV-1/2 and VZV.
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MESH Headings
- DNA Primers
- DNA, Viral/analysis
- Herpes Genitalis/virology
- Herpes Simplex/virology
- Herpes Zoster/virology
- Herpesvirus 1, Human/classification
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/classification
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 3, Human/classification
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/isolation & purification
- Humans
- Polymerase Chain Reaction/methods
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Affiliation(s)
- J M Baron
- Department of Dermatology, RWTH-Aachen, Germany
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50
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de Boer JH, Verhagen C, Bruinenberg M, Rothova A, de Jong PT, Baarsma GS, Van der Lelij A, Ooyman FM, Bollemeijer JG, Derhaag PJ, Kijlstra A. Serologic and polymerase chain reaction analysis of intraocular fluids in the diagnosis of infectious uveitis. Am J Ophthalmol 1996; 121:650-8. [PMID: 8644808 DOI: 10.1016/s0002-9394(14)70631-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Infectious uveitis entities are usually rapidly progressive blinding diseases that can be prevented by prompt administration of specific antimicrobial therapy. With the aim of improving early diagnosis in patients with infectious uveitis, intraocular fluid samples from patients with sight-threatening posterior uveitis were investigated to determine the causative agent. METHODS Thirty-eight patients with acquired immunodeficiency syndrome (AIDS) and retinitis, eight immunosuppressed patients with retinitis, 16 immunocompetent patients with acute retinal necrosis, and 22 immunocompetent patients with toxoplasmic retinochoroiditis were analyzed by polymerase chain reaction for the presence of herpesviruses and Toxoplasma gondii DNA and for local antibody production against these microorganisms. RESULTS In patients with AIDS and retinitis, polymerase chain reaction was positive for cytomegalovirus DNA in 21 (91%) of the 23 ocular fluid samples obtained during active cytomegalovirus retinitis, whereas local antibody production analysis was negative in all cases. In acute retinal necrosis, varicella-zoster virus or herpes simplex virus could be established as the inciting agent in 81% of the cases, using the combination of both techniques. Polymerase chain reaction was positive in all samples obtained within two weeks after the onset of disease. Toxoplasma gondii DNA was detected in 4 of 13 samples (31%) from immuno-competent patients with active toxoplasmic retinochoroiditis; in each case, local antibody production was also detected. In contrast, no local antibody production was observed in two of three samples from transplant recipients that were positive for T. gondii DNA. All the control samples tested were negative for the above-mentioned tests. CONCLUSIONS In patients with AIDS, polymerase chain reaction analysis is preferable above local antibody production in detecting the inciting agent of retinitis. In other cases, the combination of both techniques can make a valuable contribution to the diagnosis.
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MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- Animals
- Antibodies, Protozoan/analysis
- Antibodies, Viral/analysis
- Aqueous Humor/parasitology
- Aqueous Humor/virology
- Base Sequence
- Cytomegalovirus/genetics
- Cytomegalovirus/immunology
- DNA Primers/chemistry
- DNA, Protozoan/analysis
- DNA, Viral/analysis
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/parasitology
- Eye Infections, Viral/virology
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/immunology
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/immunology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Humans
- Immunocompromised Host
- Molecular Sequence Data
- Polymerase Chain Reaction/methods
- Retinitis/parasitology
- Retinitis/virology
- Serologic Tests
- Toxoplasma/genetics
- Toxoplasma/immunology
- Toxoplasmosis, Ocular/diagnosis
- Toxoplasmosis, Ocular/parasitology
- Toxoplasmosis, Ocular/virology
- Uveitis, Posterior/diagnosis
- Uveitis, Posterior/parasitology
- Uveitis, Posterior/virology
- Vitreous Body/parasitology
- Vitreous Body/virology
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Affiliation(s)
- J H de Boer
- The Netherlands Ophthalmic Research Institute, Amsterdam, The Netherlands
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