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Hatami P, Aryanian Z, Asl HN, Khayyat A, Hatami D. Pregnancy and pityriasis rosea: Current concepts. J Cosmet Dermatol 2024; 23:2298-2300. [PMID: 38348731 DOI: 10.1111/jocd.16233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Nicknam Asl
- Department of Dentistry, Rafsanjan University of Medical Sciences (RUMS), Rafsanjan, Iran
| | - Azadeh Khayyat
- PGY2 resident physician, Pathology Department of Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Dorsa Hatami
- Student Research Center, Kharazmi University, Tehran, Iran
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Wenger-Oehn L, Graier T, Ambros-Rudolph C, Müllegger R, Bittighofer C, Wolf P, Hofer A. Pityriasis rosea in der Schwangerschaft: Eine Fallserie und Literaturübersicht. J Dtsch Dermatol Ges 2022; 20:953-960. [PMID: 35881085 DOI: 10.1111/ddg.14763_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lena Wenger-Oehn
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Thomas Graier
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | | | - Robert Müllegger
- Abteilung für Dermatologie und Venerologie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Österreich
| | - Christina Bittighofer
- Abteilung für Dermatologie und Venerologie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Österreich
| | - Peter Wolf
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Angelika Hofer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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Wenger-Oehn L, Graier T, Ambros-Rudolph C, Müllegger R, Bittighofer C, Wolf P, Hofer A. Pityriasis rosea in pregnancy: A case series and literature review. J Dtsch Dermatol Ges 2022; 20:953-959. [PMID: 35616213 PMCID: PMC9542365 DOI: 10.1111/ddg.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
Background and objective Pityriasis rosea (PR), a common skin disease in young adults, may adversely affects the course of pregnancy and the unborn child. Patients and methods Data from forty‐six pregnant women with PR seen in the dermatological university clinic between 2003 and 2018 were analyzed and compared with patient data (n = 53) from previously published studies to determine the incidence and risk factors for an unfavorable pregnancy outcome after PR infection. Results Unfavorable pregnancy outcomes (defined as miscarriage, preterm delivery before week 37 of gestation, or birth weight < 2,500 g) were significantly less frequent in our study population than in a pooled cohort obtained from previously published studies (10.9 % vs. 39.6 %; P = 0.0012). Analysis of pooled data from our study and from previous studies revealed that the week of pregnancy at onset of PR was inversely associated with an unfavorable outcome (odds ratio [OR] = 0.937; 95 % CI 0.883 to 0.993). In addition, duration of PR (OR = 1.432; 95 % CI 1.129 to 1.827), additional extracutaneous symptoms (OR = 4.112; 95 % CI 1.580 to 10.23), and widespread rash distribution (OR 5.203, 95 % CI 1.702 to 14.89) were directly associated with unfavorable outcome. Conclusion In most cases, PR does not influence pregnancy or birth outcomes.
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Affiliation(s)
- Lena Wenger-Oehn
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | - Thomas Graier
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | | | - Robert Müllegger
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | | | - Peter Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | - Angelika Hofer
- Department of Dermatology and Venereology, Medical University of Graz, Austria
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Drago F, Ciccarese G, Casazza S, Parodi A. Pityriasis rosea, human herpesvirus 6 infection and pregnancy. J Med Virol 2022; 94:4069-4070. [PMID: 35556254 DOI: 10.1002/jmv.27852] [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: 02/22/2022] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022]
Abstract
we read the interesting article by Bortolotti et al. on the relationship between human herpesvirus 6 (HHV-6) infection and intrauterine growth restriction (IUGR)1 that prompted us to describe our experience about pityriasis rosea (PR) occurring during pregnancy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Francesco Drago
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Giulia Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Stefania Casazza
- Unit of Dermatology, Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - Aurora Parodi
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy.,Pathology Unit, Galliera Hospitals, Via Mura delle Cappuccine, 14, 16128, Genoa, Italy
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Heydarifard Z, Zadheidar S, Yavarian J, Shatizadeh Malekshahi S, Kalantari S, Mokhtari-Azad T, Shafiei-Jandaghi NZ. Potential role of viral infections in miscarriage and insights into the underlying molecular mechanisms. Congenit Anom (Kyoto) 2022; 62:54-67. [PMID: 34961973 DOI: 10.1111/cga.12458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Intrauterine viruses can infect the decidua and placenta and cause adverse effects on the fetus during gestation. This review discusses the contribution of various viral infections to miscarriage and the molecular mechanisms by which viruses can cause devastating effects on healthy fetuses and induce miscarriage. Severe acute respiratory syndrome coronavirus 2 as newly emerged coronavirus was considered here, due to the concerns about its role during pregnancy and inducing miscarriage, as well. In this narrative review, an extensive literature search was conducted to find all studies investigating viral infections in miscarriage and their molecular mechanisms published over the past 20 years. The results of various studies investigating the roles of 20 viral infections in miscarriage are presented. Then, the mechanisms of pregnancy loss in viral infections were addressed, including alteration of trophoblast invasion and placental dysfunction, inducing excessive maternal immune response, and inducing apoptosis in the placental tissue. Viruses may cause pregnancy loss through different mechanisms and our knowledge about these mechanisms can be helpful for controlling or preventing viral infections and achieving a successful pregnancy.
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Affiliation(s)
- Zahra Heydarifard
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sevrin Zadheidar
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shirin Kalantari
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Witney AA, Aller S, Strang BL. Metagenomic profiling of placental tissue suggests DNA virus infection of the placenta is rare. J Gen Virol 2021; 102. [PMID: 34723784 PMCID: PMC8742990 DOI: 10.1099/jgv.0.001677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
It is widely recognized that pathogens can be transmitted across the placenta from mother to foetus. Recent re-evaluation of metagenomic studies indicates that the placenta has no unique microbiome of commensal bacteria. However, viral transmission across the placenta, including transmission of DNA viruses such as the human herpesviruses, is possible. A fuller understanding of which DNA virus sequence can be found in the placenta is required. We employed a metagenomic analysis to identify viral DNA sequences in placental metagenomes from full-term births (20 births), pre-term births (13 births), births from pregnancies associated with antenatal infections (12 births) or pre-term births with antenatal infections (three births). Our analysis found only a small number of DNA sequences corresponding to the genomes of human herpesviruses in four of the 48 metagenomes analysed. Therefore, our data suggest that DNA virus infection of the placenta is rare and support the concept that the placenta is largely free of pathogen infection.
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Affiliation(s)
- Adam A Witney
- Institute for Infection and Immunity, St George's, University of London, London SW17 0RE, UK
| | - Sean Aller
- Institute for Infection and Immunity, St George's, University of London, London SW17 0RE, UK
| | - Blair L Strang
- Institute for Infection and Immunity, St George's, University of London, London SW17 0RE, UK
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Shmeleva EV, Colucci F. Maternal natural killer cells at the intersection between reproduction and mucosal immunity. Mucosal Immunol 2021; 14:991-1005. [PMID: 33903735 PMCID: PMC8071844 DOI: 10.1038/s41385-020-00374-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
Many maternal immune cells populate the decidua, which is the mucosal lining of the uterus transformed during pregnancy. Here, abundant natural killer (NK) cells and macrophages help the uterine vasculature adapt to fetal demands for gas and nutrients, thereby supporting fetal growth. Fetal trophoblast cells budding off the forming placenta and invading deep into maternal tissues come into contact with these and other immune cells. Besides their homeostatic functions, decidual NK cells can respond to pathogens during infection, but in doing so, they may become conflicted between destroying the invader and sustaining fetoplacental growth. We review how maternal NK cells balance their double duty both in the local microenvironment of the uterus and systemically, during toxoplasmosis, influenza, cytomegalovirus, malaria and other infections that threat pregnancy. We also discuss recent developments in the understanding of NK-cell responses to SARS-Cov-2 infection and the possible dangers of COVID-19 during pregnancy.
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Affiliation(s)
- Evgeniya V Shmeleva
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, CB2 0SW, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Francesco Colucci
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, CB2 0SW, UK.
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
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Porras-Villamil JF, Hinestroza AC, López-Moreno GA, Parra-Sepúlveda DJ. Atypical pityriasis rosea in a young Colombian woman. Case report. CASE REPORTS 2021. [DOI: 10.15446/cr.v7n2.88809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Pityriasis rosea is an acute and self-limited exanthemfirst described by Gilbert in 1860. Its treatment is symptomatic, and although there is no conclusive evidence, it has been associated with the reactivation of the human herpesviruses 6 and 7 (HHV-6 and HHV-7).
Case presentation: A 28-year-old woman, from Bogotá, Colombia, ahealth worker, attended the emergency room due to the onset ofsymptoms that began 20 days earlier with the appearance of punctiformlesions in the left arm that later spread to the thorax, abdomen, opposite arm, and thighs. The patient reported a history of bipolar II disorder and retinal detachment. After ruling out several infectious diseases, and due to the evolution of the symptoms, pityriasis rosea was suspected. Therefore, treatment was started with deflazacort 30mg for 21 days, obtaining a favorable outcome and improvement of symptoms after 2 months. At the time of writing this case report, the patient had not consulted for recurrence.
Conclusion: Primary care physicians should have sufficient training indermatology to recognize and treat dermatological diseases since manyof them are diagnosed based on clinical findings. This is an atypicalcase, in which the patient did not present with some of the pathognomonic signs associated with pityriasis rosea.
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Fölster-Holst R. Infectious exanthemas in childhood. J Dtsch Dermatol Ges 2021; 18:1128-1155. [PMID: 33112060 DOI: 10.1111/ddg.14301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022]
Abstract
Most childhood exanthemas are harmless. However, recognizing serious diseases with life-threatening complications at an early stage is important for the timely initiation of adequate therapy. This requires knowledge of the specific patterns of the exanthema, obtained from the medical history and the clinic, including the patient's general condition and physical examination. In unclear cases, additional diagnostic measures are undertaken, such as blood tests and smears (cutaneous, mucocutaneous). Viruses are the most common cause of childhood exanthemas. New variants of infectious agents, improved diagnostics and stays in tropical and subtropical countries have expanded the spectrum of infectious exanthemas.
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Affiliation(s)
- Regina Fölster-Holst
- Dermatology, Venereology, Allergology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
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Is the ZIKV Congenital Syndrome and Microcephaly Due to Syndemism with Latent Virus Coinfection? Viruses 2021; 13:v13040669. [PMID: 33924398 PMCID: PMC8069280 DOI: 10.3390/v13040669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 01/04/2023] Open
Abstract
The emergence of the Zika virus (ZIKV) mirrors its evolutionary nature and, thus, its ability to grow in diversity or complexity (i.e., related to genome, host response, environment changes, tropism, and pathogenicity), leading to it recently joining the circle of closed congenital pathogens. The causal relation of ZIKV to microcephaly is still a much-debated issue. The identification of outbreak foci being in certain endemic urban areas characterized by a high-density population emphasizes that mixed infections might spearhead the recent appearance of a wide range of diseases that were initially attributed to ZIKV. Globally, such coinfections may have both positive and negative effects on viral replication, tropism, host response, and the viral genome. In other words, the possibility of coinfection may necessitate revisiting what is considered to be known regarding the pathogenesis and epidemiology of ZIKV diseases. ZIKV viral coinfections are already being reported with other arboviruses (e.g., chikungunya virus (CHIKV) and dengue virus (DENV)) as well as congenital pathogens (e.g., human immunodeficiency virus (HIV) and cytomegalovirus (HCMV)). However, descriptions of human latent viruses and their impacts on ZIKV disease outcomes in hosts are currently lacking. This review proposes to select some interesting human latent viruses (i.e., herpes simplex virus 2 (HSV-2), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), human parvovirus B19 (B19V), and human papillomavirus (HPV)), whose virological features and co-exposition with ZIKV may provide evidence of the syndemism process, shedding some light on the emergence of the ZIKV-induced global congenital syndrome in South America.
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Komaroff AL, Rizzo R, Ecker JL. Human Herpesviruses 6A and 6B in Reproductive Diseases. Front Immunol 2021; 12:648945. [PMID: 33841432 PMCID: PMC8027340 DOI: 10.3389/fimmu.2021.648945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
Human herpesviruses 6A (HHV-6A) and human herpesvirus 6B (HHV-6B)—collectively, HHV-6A/B—are recently-discovered but ancient human viruses. The vast majority of people acquire one or both viruses, typically very early in life, producing an ineradicable lifelong infection. The viruses have been linked to several neurological, pulmonary and hematological diseases. In early human history, the viruses on multiple occasions infected a germ cell, and integrated their DNA into a human chromosome. As a result, about 1% of humans are born with the full viral genome present in every cell, with uncertain consequences for health. HHV-6A may play a role in 43% of cases of primary unexplained infertility. Both the inherited and acquired viruses may occasionally trigger several of the factors that are important in the pathogenesis of preeclampsia. Transplacental infection occurs in 1-2% of pregnancies, with some evidence suggesting adverse health consequences for the child. While emerging knowledge about these viruses in reproductive diseases is not sufficient to suggest any changes in current practice, we write this review to indicate the need for further research that could prove practice-changing.
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Affiliation(s)
- Anthony L Komaroff
- Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Roberta Rizzo
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Jeffrey L Ecker
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Fölster-Holst R. Infektiöse Exantheme im Kindesalter. J Dtsch Dermatol Ges 2020; 18:1128-1157. [PMID: 33112074 DOI: 10.1111/ddg.14301_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Regina Fölster-Holst
- Dermatologie, Venerologie, Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
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Farsimadan M, Motamedifar M. The effects of human immunodeficiency virus, human papillomavirus, herpes simplex virus-1 and -2, human herpesvirus-6 and -8, cytomegalovirus, and hepatitis B and C virus on female fertility and pregnancy. Br J Biomed Sci 2020; 78:1-11. [PMID: 32726192 DOI: 10.1080/09674845.2020.1803540] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Female infertility may be defined as a woman of reproductive age being unable to become pregnant after a year of regular unprotected sexual intercourse. Social, genetic, endocrine, physiological, and psychological factors as well as lifestyle habits (i.e., smoking and alcohol consumption), either alone or in combination with male factors, are major causes. However, approximately 15-30% of cases of female infertility remain unexplained. Numerous investigations have also indicated that microbiomes play an important role in human reproduction. All parts of the female reproductive system may be influenced by infectious and pathological agents, especially viruses, and these may interfere with reproductive function and so are risk factors for infertility, although in many cases an exact role is unclear. We present an overview of the impact of common viral infections on female reproduction, searching Medline, PubMed, Scopus, and Google scholar databases for potentially relevant studies of viruses known to have a potential effect. Human immunodeficiency virus (HIV), herpes simplex virus (HSV) and human herpesvirus (HHV) increase infertility rates whilst human papillomavirus (HPV), cytomegalovirus (CMV), and hepatitis B and C virus (HBV, HCV) infections mostly lead to higher abortion and miscarriage rates. Moreover, HPV infection is linked to increased tubal infertility, endometriosis, and pelvic inflammatory disease. HPV was the most frequently observed infection and with lower pregnancy rate and foetal death in women undergoing IVF treatments. Assisted reproductive treatment could be a safe and effective approach for HIV and HBV infected women.
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Affiliation(s)
- M Farsimadan
- Department of Biology, Faculty of Sciences, University of Guilan , Rasht, Iran
| | - M Motamedifar
- Department of Bacteriology and Virology, Shiraz Medical School, and Shiraz HIV/Aids Research Center, Institute of Health, Shiraz University of Medical Sciences , Shiraz, Iran
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Kim F, Reichman V, Hooven TA. Human Herpesvirus-6 Meningitis in a Premature Infant with Fevers: A Case and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2020; 13:1179547620912952. [PMID: 32341669 PMCID: PMC7169356 DOI: 10.1177/1179547620912952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/20/2020] [Indexed: 01/27/2023]
Abstract
Human herpesvirus-6 (HHV-6) is a common virus that can cause nearly universal infection in infancy and early childhood. It typically manifests as an acute febrile illness. We describe a case of a premature infant with congenital hydrocephalus secondary to aqueductal stenosis with a ventriculoperitoneal shunt in place who developed intermittent fevers while she was admitted to the neonatal intensive care unit. She was ultimately diagnosed with acute HHV-6 meningitis. In addition to this report, we present a literature review regarding this virus’s potential modes of transmission and forms of clinical presentation in the neonatal period.
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Affiliation(s)
- Faith Kim
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Victoria Reichman
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Thomas A Hooven
- Division of Neonatology/Newborn Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Thomas A Hooven, Division of Neonatology/Newborn Medicine, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Rangos Research Building #8128, Pittsburgh, PA 15224, USA.
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Management guidelines for pregnant health care workers exposed to infectious dermatoses. Int J Womens Dermatol 2020; 6:142-151. [PMID: 32313827 PMCID: PMC7165119 DOI: 10.1016/j.ijwd.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Exanthematous diseases are frequently of infectious origin, posing risks, especially for pregnant health care workers (HCWs) who treat them. The shift from cell-mediated (Th1 cytokine profile) to humoral (Th2 cytokine profile) immunity during pregnancy can influence the mother’s susceptibility to infection and lead to complications for both mother and fetus. The potential for vertical transmission must be considered when evaluating the risks for pregnant HCWs treating infected patients because fetal infection can often have devastating consequences. Given the high proportion of women of childbearing age among HCWs, the pregnancy-related risks of exposure to infectious diseases are an important topic in both patient care and occupational health. Contagious patients with cutaneous manifestations often present to dermatology or pediatric clinics, where female providers are particularly prevalent; a growing number of these physicians are female. Unfortunately, the risks of infection for pregnant HCWs are not well defined. To our knowledge, there is limited guidance on safe practices for pregnant HCWs who encounter infectious dermatologic diseases. In this article, we review several infectious exanthems, their transmissibility to pregnant women, the likelihood of vertical transmission, and the potential consequences of infection for the mother and fetus. Additionally, we discuss recommendations with respect to avoidance, contact, and respiratory precautions, as well as the need for treatment after exposure.
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Contreras‐Ruiz J, Peternel S, Jiménez Gutiérrez C, Culav‐Koscak I, Reveiz L, Silbermann‐Reynoso MDL. Interventions for pityriasis rosea. Cochrane Database Syst Rev 2019; 2019:CD005068. [PMID: 31684696 PMCID: PMC6819167 DOI: 10.1002/14651858.cd005068.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pityriasis rosea is a scaly, itchy rash that mainly affects young adults and lasts for 2 to 12 weeks. The effects of many available treatments are uncertain. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To assess the effects of interventions for the management of pityriasis rosea in any individual diagnosed by a medical practitioner. SEARCH METHODS We updated our searches of the following databases to October 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched five trials registers. We also checked the reference lists of included and excluded studies, contacted trial authors, scanned the abstracts from major dermatology conference proceedings, and searched the CAB Abstracts database. We searched PubMed for adverse effects to November 2018. SELECTION CRITERIA Randomised controlled trials of interventions in pityriasis rosea. Treatment could be given in a single therapy or in combination. Eligible comparators were no treatment, placebo, vehicle only, another active compound, or placebo radiation treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane. Our key outcomes were good or excellent rash improvement within two weeks, rated separately by the participant and medical practitioner; serious adverse events; resolution of itch within two weeks (participant-rated); reduction in itch score within two weeks (participant-rated); and minor participant-reported adverse events not requiring withdrawal of the treatment. MAIN RESULTS We included 14 trials (761 participants). In general, risk of selection bias was unclear or low, but risk of performance bias and reporting bias was high for 21% of the studies. Participant age ranged from 2 to 60 years, and sex ratio was similar. Disease severity was measured by various severity indices, which the included studies did not categorise. Six studies were conducted in India, three in Iran, two in the Philippines, and one each in Pakistan, the USA, and China. The included studies were conducted in dermatology departments and a paediatric clinic. Study duration ranged from 5 to 26 months. Three studies were funded by drug manufacturers; most studies did not report their funding source. The included studies assessed macrolide antibiotics, an antiviral agent, phototherapy, steroids and antihistamine, and Chinese medicine. None of the studies measured participant-rated good or excellent rash improvement. All reported outcomes were assessed within two weeks of treatment, except for adverse effects, which were measured throughout treatment. There is probably no difference between oral clarithromycin and placebo in itch resolution (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.47 to 1.52; 1 study, 28 participants) or rash improvement (medical practitioner-rated) (RR 1.13, 95% CI 0.89 to 1.44; 1 study, 60 participants). For this comparison, there were no serious adverse events (1 study, 60 participants); minor adverse events and reduction in itch score were not measured; and all evidence was of moderate quality. When compared with placebo, erythromycin may lead to increased rash improvement (medical practitioner-rated) (RR 4.02, 95% CI 0.28 to 56.61; 2 studies, 86 participants, low-quality evidence); however, the 95% CI indicates that the result may also be compatible with a benefit of placebo, and there may be little or no difference between treatments. Itch resolution was not measured, but one study measured reduction in itch score, which is probably larger with erythromycin (MD 3.95, 95% CI 3.37 to 4.53; 34 participants, moderate-quality evidence). In the same single, small trial, none of the participants had a serious adverse event, and there was no clear difference between groups in minor adverse events, which included gastrointestinal upset (RR 2.00, CI 0.20 to 20.04; moderate-quality evidence). Two trials compared oral azithromycin to placebo or vitamins. There is probably no difference between groups in itch resolution (RR 0.83, 95% CI 0.28 to 2.48) or reduction in itch score (MD 0.04, 95% CI -0.35 to 0.43) (both outcomes based on one study; 70 participants, moderate-quality evidence). Low-quality evidence from two studies indicates there may be no difference between groups in rash improvement (medical practitioner-rated) (RR 1.02, 95% CI 0.52 to 2.00; 119 participants). In these same two studies, no serious adverse events were reported, and there was no clear difference between groups in minor adverse events, specifically mild abdominal pain (RR 5.82, 95% CI 0.72 to 47.10; moderate-quality evidence). Acyclovir was compared to placebo, vitamins, or no treatment in three trials (all moderate-quality evidence). Based on one trial (21 participants), itch resolution is probably higher with placebo than with acyclovir (RR 0.34, 95% CI 0.12 to 0.94); reduction in itch score was not measured. However, there is probably a significant difference between groups in rash improvement (medical practitioner-rated) in favour of acyclovir versus all comparators (RR 2.45, 95% CI 1.33 to 4.53; 3 studies, 141 participants). Based on the same three studies, there were no serious adverse events in either group, and there was probably no difference between groups in minor adverse events (only one participant in the placebo group experienced abdominal pain and diarrhoea). One trial compared acyclovir added to standard care (calamine lotion and oral cetirizine) versus standard care alone (24 participants). The addition of acyclovir may lead to increased itch resolution (RR 4.50, 95% CI 1.22 to 16.62) and reduction in itch score (MD 1.26, 95% CI 0.74 to 1.78) compared to standard care alone. Rash improvement (medical practitioner-rated) was not measured. The trial reported no serious adverse events in either group, and there may be no difference between groups in minor adverse events, such as headache (RR 7.00, 95% CI 0.40 to 122.44) (all results based on low-quality evidence). AUTHORS' CONCLUSIONS When compared with placebo or no treatment, oral acyclovir probably leads to increased good or excellent, medical practitioner-rated rash improvement. However, evidence for the effect of acyclovir on itch was inconclusive. We found low- to moderate-quality evidence that erythromycin probably reduces itch more than placebo. Small study sizes, heterogeneity, and bias in blinding and selective reporting limited our conclusions. Further research is needed to investigate different dose regimens of acyclovir and the effect of antivirals on pityriasis rosea.
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Affiliation(s)
- Jose Contreras‐Ruiz
- Hospital General Dr. Manuel Gea GonzálezDepartment of DermatologyPuente de Piedra 150‐T1‐C111. Col. Toriello GuerraMexico CityMexico14050
| | - Sandra Peternel
- Clinical Hospital Center RijekaDepartment of DermatovenereologyKresimirova 42RijekaCroatia51000
- University of Rijeka, Faculty of MedicineRijekaCroatia51000
| | - Carlos Jiménez Gutiérrez
- Universidad Tecnologica de México‐Laureate International UniversitiesAdscrito Unidad de Investigación TraslacionalKinchil 234‐3Col. Heroes de Padierna. Delegación TlalpanMéxico.DFDFMexico14200
| | - Ivana Culav‐Koscak
- General hospital "Dr. Ivo Pedisic"Department of Dermatology and VenereologyJ.J. Strossmayera 59SisakCroatia44000
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Rebora A, Ciccarese G, Herzum A, Parodi A, Drago F. Pityriasis rosea and other infectious eruptions during pregnancy: Possible life-threatening health conditions for the fetus. Clin Dermatol 2019; 38:105-112. [PMID: 32197740 DOI: 10.1016/j.clindermatol.2019.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Any infectious illness presenting with an eruption in a pregnant patient may be associated with an increased risk of fetal loss. The viruses that can infect the placenta during maternal infection and can be transmitted to the fetus and cause congenital disease include the rubella virus, the measles virus, the varicella zoster virus, parvovirus B19, human cytomegalovirus, arboviruses, and hepatitis E virus type 1. In addition, some bacteria responsible for exanthematous diseases, like Treponema pallidum, can be transmitted during pregnancy from the mother to the fetus and cause fetal loss. All these infectious agents can cause typical and/or atypical exanthems whose etiologic diagnosis is sometimes difficult but important to determine, especially in pregnant women because of the potential risk to the fetus. In the last 20 years, we have extensively studied pityriasis rosea from the clinical and laboratory perspectives, demonstrating the pathogenic role of human herpesvirus (HHV)-6 and -7. We synthesize the available evidence that PR may be associated with active HHV-6/7 infection and therefore with complications during pregnancy and fetal loss. We have also summarized the emerging infectious illnesses of dermatologic interest that may represent life-threatening health conditions for the fetus: measles, rubella, arbovirus infection, and syphilis.
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Affiliation(s)
- Alfredo Rebora
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Giulia Ciccarese
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Astrid Herzum
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Aurora Parodi
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Francesco Drago
- Dermatologic Clinic, Policlinico San Martino, Largo R. Benzi 10, 16132 Genoa, Italy
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Affiliation(s)
- Christina Schnopp
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein der TU München, Biedersteinerstr. 29, D-80802, München, Deutschland.
| | - Andreas Weins
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein der TU München, Biedersteinerstr. 29, D-80802, München, Deutschland
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Calvario A, Foti C, Scarasciulli M, Romita P, Eliassen E, Marzullo A, Colacicco AM, Miragliotta G. Leukocytoclastic Vasculitis Associated with HHV6-A/ciHHV6-A and HHV6-B Coinfection in an Immunocompetent Woman. Endocr Metab Immune Disord Drug Targets 2019; 19:221-225. [DOI: 10.2174/1871530318666181106153758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 09/19/2018] [Accepted: 10/26/2018] [Indexed: 01/08/2023]
Abstract
Background and Objective: Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis that can be limited to the skin but may also affect other organs. Often, its cause is unknown. LCV has previously been reported to occur with the reactivation of human herpesvirus 6 (HHV-6). Here, we report a second instance of HHV-6 reactivation in a 43-year-old woman with idiopathic cutaneous LCV. </P><P> Case Description: In this case, the patient was immunocompetent, and testing revealed that she had inherited chromosomally integrated human herpesvirus 6 variant A (iciHHV6-A) with a parallel skin infection of HHV-6B. The integrated ciHHV-6A strain was found to be transcriptionally active in the blood, while HHV-6B late antigen was detected in a skin biopsy. The patient’s rash was not accompanied by fever nor systemic symptoms and resolved over four weeks without any therapeutic intervention.Conclusion:In light of the transcriptional activity documented in our case, further examination of a possible role for HHV-6 in the etiology of LCV is warranted.
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Affiliation(s)
- Agata Calvario
- Microbiology and Virology Unit, Policlinico University Hospital of Bari, Italy
| | - Caterina Foti
- Dermatological Clinic, Department of Biomedical Science and Human Oncology, University of Bari, Italy
| | - Maria Scarasciulli
- Microbiology and Virology Unit, Policlinico University Hospital of Bari, Italy
| | - Paolo Romita
- Dermatological Clinic, Department of Biomedical Science and Human Oncology, University of Bari, Italy
| | - Eva Eliassen
- HHV-6 Foundation, Santa Barbara, CA, United States
| | - Andrea Marzullo
- Department of Emergency and Transplant Organ, University of Bari, Italy
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Pityriasis rosea in a patient with retrovirus infection: a reply. Postepy Dermatol Alergol 2018; 35:116-117. [PMID: 29599683 PMCID: PMC5872253 DOI: 10.5114/ada.2018.73172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/17/2022] Open
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Handler N, Handler M, Rubins A, Rubins S, Septe M, Janniger C, Schwartz R. Milker's nodule: an occupational infection and threat to the immunocompromised. J Eur Acad Dermatol Venereol 2018; 32:537-541. [DOI: 10.1111/jdv.14687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/17/2017] [Indexed: 01/30/2023]
Affiliation(s)
- N.S. Handler
- Dermatology Department; New Jersey Medical School; Rutgers University School of Public Affairs and Administration; Newark NJ USA
| | - M.Z. Handler
- Dermatology Department; New Jersey Medical School; Rutgers University School of Public Affairs and Administration; Newark NJ USA
| | - A. Rubins
- Department of Dermatovenerology; Faculty of Medicine; University of Latvia; Riga Latvia
| | - S. Rubins
- Department of Dermatovenerology; Faculty of Medicine; University of Latvia; Riga Latvia
| | - M. Septe
- Department of Dermatovenerology; Faculty of Medicine; University of Latvia; Riga Latvia
| | - C.K. Janniger
- Dermatology Department; New Jersey Medical School; Rutgers University School of Public Affairs and Administration; Newark NJ USA
| | - R.A. Schwartz
- Dermatology Department; New Jersey Medical School; Rutgers University School of Public Affairs and Administration; Newark NJ USA
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Drago F, Javor S, Ponte R, Fraternali Orcioni G, Parodi A, Rebora A. Epstein-Barr virus exanthem in an adult patient with myelodysplastic syndrome. Clin Exp Dermatol 2017; 43:366-368. [PMID: 29274098 DOI: 10.1111/ced.13340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/17/2022]
Affiliation(s)
- F Drago
- Department of Dermatology, DISSAL, IRCCS AOU San Martino-IST, Genoa, Italy
| | - S Javor
- Department of Dermatology, DISSAL, IRCCS AOU San Martino-IST, Genoa, Italy
| | - R Ponte
- Pathology Unit, Department of Surgical Science and Integrated Diagnostics, University of Genoa, IRCCS AOU. San Martino-IST, Genoa, Italy
| | - G Fraternali Orcioni
- Pathology Unit, Department of Surgical Science and Integrated Diagnostics, University of Genoa, IRCCS AOU. San Martino-IST, Genoa, Italy
| | - A Parodi
- Department of Dermatology, DISSAL, IRCCS AOU San Martino-IST, Genoa, Italy
| | - A Rebora
- Department of Dermatology, DISSAL, IRCCS AOU San Martino-IST, Genoa, Italy
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Fu LY, Xu CC, Zheng XD, Chen G, Zhu J, Wang PG. Association of HLA-DQB1*03:03 with pityriasis rosea in Chinese patients. Clin Exp Dermatol 2017; 43:389-392. [PMID: 29222811 DOI: 10.1111/ced.13313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L.-Y. Fu
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - C.-C. Xu
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - X.-D. Zheng
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - G. Chen
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - J. Zhu
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - P.-G. Wang
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
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Drago F, Ciccarese G, Cioni M, Gariazzo L, Parodi A. Simultaneous occurrence of hand, foot and mouth disease and pityriasis rosea: double viral exanthem. GIORN ITAL DERMAT V 2017; 154:85-86. [PMID: 29144097 DOI: 10.23736/s0392-0488.17.05604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Drago
- DISSAL Department of Dermatology, IRCCS A.O.U, San Martino-IST, Genoa, Italy
| | - Giulia Ciccarese
- DISSAL Department of Dermatology, IRCCS A.O.U, San Martino-IST, Genoa, Italy -
| | - Margherita Cioni
- DISSAL Department of Dermatology, IRCCS A.O.U, San Martino-IST, Genoa, Italy
| | - Lodovica Gariazzo
- DISSAL Department of Dermatology, IRCCS A.O.U, San Martino-IST, Genoa, Italy
| | - Aurora Parodi
- DISSAL Department of Dermatology, IRCCS A.O.U, San Martino-IST, Genoa, Italy
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Abstract
Paraviral exanthems are distinct skin diseases due to infections with different viruses. Although no virus has been identified so far in some exanthems, the main age of manifestation, the clinical course of the exanthem, and the extracutaneous symptoms are suggestive for a viral genesis. While many viral infections are a direct result of the infection, paraviral exanthems reflect the response of the immune system to the infectious pathogens. Viruses cannot be identified in the skin. Typical paraviral exanthems include Gianotti-Crosti syndrome, pityriasis rosea, pityriasis lichenoides, papular-purpuric gloves and sock syndrome, and asymmetrical periflexural exanthema. Unilateral mediothoracic exanthem, eruptive pseudoangiomatosis are rare and eruptive hypomelanosis has been described recently.
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Ciccarese G, Broccolo F, Rebora A, Parodi A, Drago F. Oropharyngeal lesions in pityriasis rosea. J Am Acad Dermatol 2017; 77:833-837.e4. [DOI: 10.1016/j.jaad.2017.06.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 01/21/2023]
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Eliassen E, Marci R, Di Luca D, Rizzo R. The use of heparin in infertility and recurrent pregnancy loss: Are its antiviral properties at play? Med Hypotheses 2017; 102:41-47. [DOI: 10.1016/j.mehy.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 03/05/2017] [Indexed: 12/31/2022]
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Loh TY, Cohen PR. Pityriasis rosea in pregnancy: report of a spousal occurrence and craniosynostosis in the healthy newborn. Dermatol Pract Concept 2016; 6:39-46. [PMID: 27648382 PMCID: PMC5006551 DOI: 10.5826/dpc.0603a08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/01/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Pityriasis rosea is a papulosquamous disease. It may occur during pregnancy; in this setting, it has occasionally been associated with adverse outcomes. PURPOSE A woman who developed pityriasis rosea at the beginning of her eighth week of gestation is described. The outcomes in newborns delivered by pregnant women who developed pityriasis rosea during gestation are summarized. METHOD A 28-year-old woman developed pityriasis rosea during her eighth week of pregnancy. Her husband had pityriasis rosea two months earlier. PubMed was searched for the following terms: conjugal, craniosynostosis, newborn, pityriasis, pregnancy, rosea, sagittal, spouse. The papers were reviewed and the references cited were evaluated. RESULTS Our patient delivered a healthy male infant after 41 weeks of gestation. He had normal weight, height, and Apgar scores. Isolated sagittal craniosynostosis was diagnosed and was successfully treated at nine weeks after birth without complications. CONCLUSION Several retrospective studies have investigated the possibility of adverse outcomes in infants born to women who developed pityriasis rosea during pregnancy, such as stillbirth, low gestational weight, hypotonia, and premature delivery. However, there are also reports of healthy newborns in women who have had pityriasis rosea during gestation. Our patient carried the fetus one week post-term and delivered a healthy boy via C-section; isolated sagittal craniosynostosis was later diagnosed and successfully repaired. The occurrence of craniosynostosis in a woman who developed pityriasis rosea during her first trimester of pregnancy may be two coincidental events.
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Affiliation(s)
- Tiffany Y Loh
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA
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Mahajan K, Relhan V, Relhan AK, Garg VK. Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects. Indian J Dermatol 2016; 61:375-84. [PMID: 27512182 PMCID: PMC4966395 DOI: 10.4103/0019-5154.185699] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pityriasis rosea (PR) is a benign papulosquamous disorder seen commonly in clinical practice. Despite its prevalence and benign nature, there are still times when this common disorder presents in an uncommon way or course posing diagnostic or management problems for the treating physician. The etiopathogenesis of PR has always been a dilemma, and extensive research is going on to elicit the exact cause. This review focuses mainly on the difficult aspects of this benign common disorder such as etiopathogenesis, atypical manifestations, recurrent cases, differential diagnosis, therapy and pregnancy considerations. Although we could not find a black and white solution to all these problems, we have tried to compile the related literature to draw out some conclusions.
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Affiliation(s)
- Khushbu Mahajan
- Department of Dermatology, North Delhi Municipal Corporation Medical College, Hindu Rao Hospital, New Delhi, India
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Chuh A, Zawar V, Sciallis G, Kempf W. A position statement on the management of patients with pityriasis rosea. J Eur Acad Dermatol Venereol 2016; 30:1670-1681. [PMID: 27406919 DOI: 10.1111/jdv.13826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/18/2016] [Indexed: 02/02/2023]
Abstract
Many clinical trials have been conducted on the treatment of pityriasis rosea (PR). Our aim was to establish a position statement for the management of adults with PR based on the best available evidence. We searched PubMed for all reports on randomized controlled trials for the treatment of PR published in the past 30 years. We retrieved 14 articles reporting randomized controlled trials, and found five which met our quality requirements for in-depth analyses. Erythromycin was found in a well-conducted triple-blind study to cast significant impacts on clinical outcomes. However, adverse gastrointestinal effects were fairly common. Another well-conducted study on azithromycin reported no significant benefit. It was reported in three well-conducted studies on oral acyclovir in low dose (400 mg three times daily for 7 days or 400 mg five times daily for 7 days) and high dose (800 mg five times daily for 7 days), that acyclovir is effective in attaining rash regression and lessening the pruritus. When compared against each other, the high-dose regimen demonstrated no benefit over the low-dose regimens. Our statement comprises the follows: (i) The diagnosis of PR should be ascertained; (ii) The patients should be assessed for rash severity and impacts on quality of life; (iii) PR is a self-limiting disease, and most patients do not necessitate any treatment; (iv) For patients necessitating active treatment, oral acyclovir as 400 mg three times daily for 7 days can be considered; (v) Attention should be given to adverse effects and contraindications of acyclovir; (vi) When PR occurs in early pregnancy, oral antiviral therapy could be considered after consulting experienced clinicians; (vii) Inadequate information exists in the use of acyclovir to treatment PR in children and breastfeeding women; and (viii) Treating PR is an off-label use of acyclovir, and this has to be discussed with experienced colleagues and the patients.
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Affiliation(s)
- A Chuh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong.
| | - V Zawar
- Department of Dermatology, Godavari Foundation Medical College and Research Center, DUPMCJ, Nashik, India
| | - G Sciallis
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - W Kempf
- Histologische Diagnostik, Department of Dermatology, University Hospital Zürich, Zurich, Switzerland
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Marci R, Gentili V, Bortolotti D, Lo Monte G, Caselli E, Bolzani S, Rotola A, Di Luca D, Rizzo R. Presence of HHV-6A in Endometrial Epithelial Cells from Women with Primary Unexplained Infertility. PLoS One 2016; 11:e0158304. [PMID: 27367597 PMCID: PMC4930213 DOI: 10.1371/journal.pone.0158304] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/13/2016] [Indexed: 02/03/2023] Open
Abstract
To elucidate the roles of human herpesvirus (HHV)-6 primary unexplained infertile women, a prospective randomized study was conducted on a cohort of primary unexplained infertile women and a cohort of control women, with at least one successful pregnancy. HHV-6 DNA was analyzed and the percentage and immune-phenotype of resident endometrial Natural Killer (NK) cells, as the first line of defense towards viral infections, was evaluated in endometrial biopsies. Cytokine levels in uterine flushing samples were analyzed. HHV-6A DNA was found in 43% of endometrial biopsies from primary unexplained infertile women, but not in control women. On the contrary, HHV-6B DNA was absent in endometrial biopsies, but present in PBMCs of both cohorts. Endometrial NK cells presented a different distribution in infertile women with HHV6-A infection compared with infertile women without HHV6-A infection. Notably, we observed a lower percentage of endometrial specific CD56brightCD16- NK cells. We observed an enhanced HHV-6A-specific endometrial NK cell response in HHV-6A positive infertile women, with a marked increase in the number of endometrial NK cells activating towards HHV-6A infected cells. The analysis of uterine flushing samples showed an increase in IL-10 levels and a decrease of IFN-gamma concentrations in infertile women with HHV6-A infection. Our study indicates, for the first time, that HHV-6A infection might be an important factor in female unexplained infertility development, with a possible role in modifying endometrial NK cells immune profile and ability to sustain a successful pregnancy.
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Affiliation(s)
- Roberto Marci
- Department of Morphology, Surgery and Experimental Medicine, Section of Gynecology and Obstetrics, University of Ferrara, Ferrara, Italy
- School of Medicine, University of Geneve, Geneve, Switzerland
| | - Valentina Gentili
- Department of Medical Sciences, Section of Microbiology, University of Ferrara, Ferrara, Italy
| | - Daria Bortolotti
- Department of Medical Sciences, Section of Microbiology, University of Ferrara, Ferrara, Italy
| | | | - Elisabetta Caselli
- Department of Medical Sciences, Section of Microbiology, University of Ferrara, Ferrara, Italy
| | - Silvia Bolzani
- Department of Medical Sciences, Section of Microbiology, University of Ferrara, Ferrara, Italy
| | - Antonella Rotola
- Department of Medical Sciences, Section of Microbiology, University of Ferrara, Ferrara, Italy
| | - Dario Di Luca
- Department of Medical Sciences, Section of Microbiology, University of Ferrara, Ferrara, Italy
| | - Roberta Rizzo
- Department of Medical Sciences, Section of Microbiology, University of Ferrara, Ferrara, Italy
- * E-mail:
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Yang CS, Teeple M, Muglia J, Robinson-Bostom L. Inflammatory and glandular skin disease in pregnancy. Clin Dermatol 2016; 34:335-43. [DOI: 10.1016/j.clindermatol.2016.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Drago F, Ciccarese G, Rebora A, Broccolo F, Parodi A. Pityriasis Rosea: A Comprehensive Classification. Dermatology 2016; 232:431-7. [PMID: 27096928 DOI: 10.1159/000445375] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/29/2016] [Indexed: 12/13/2022] Open
Abstract
Pityriasis rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a 'Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.
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Affiliation(s)
- Francesco Drago
- DISSAL, Department of Dermatology, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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Chuh A, Zawar V, Sciallis GF, Kempf W, Lee A. Pityriasis Rosea, Gianotti-Crosti Syndrome, Asymmetric Periflexural Exanthem, Papular-Purpuric Gloves and Socks Syndrome, Eruptive Pseudoangiomatosis, and Eruptive Hypomelanosis: Do Their Epidemiological Data Substantiate Infectious Etiologies? Infect Dis Rep 2016; 8:6418. [PMID: 27103975 PMCID: PMC4815944 DOI: 10.4081/idr.2016.6418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 12/21/2022] Open
Abstract
Many clinical and laboratory-based studies have been reported for skin rashes which may be due to viral infections, namely pityriasis rosea (PR), Gianotti-Crosti syndrome (GCS), asymmetric periflexural exanthem/unilateral laterothoracic exanthem (APE/ULE), papular-purpuric gloves and socks syndrome (PPGSS), and eruptive pseudo-angiomatosis (EP). Eruptive hypomelanosis (EH) is a newly discovered paraviral rash. Novel tools are now available to investigate the epidemiology of these rashes. To retrieve epidemiological data of these exanthema and analyze whether such substantiates or refutes infectious etiologies. We searched for articles published over the last 60 years and indexed by PubMed database. We then analyzed them for universality, demography, concurrent patients, temporal and spatial-temporal clustering, mini-epidemics, epidemics, and other clinical and geographical associations. Based on our criteria, we selected 55, 60, 29, 36, 20, and 4 articles for PR, GCS, APE/ULE, PPGSS, EP, and EH respectively. Universality or multiple-continental reports are found for all exanthema except EH. The ages of patients are compatible with infectious causes for PR, GCS, APE/ULE, and EH. Concurrent patients are reported for all. Significant patient clustering is demonstrated for PR and GCS. Mini-epidemics and epidemics have been reported for GCS, EP, and EH. The current epidemiological data supports, to a moderate extent, that PR, GCS, and APE could be caused by infectious agents. Support for PPGSS is marginal. Epidemiological evidences for infectious origins for EP and EH are inadequate. There might be growing epidemiological evidence to substantiate or to refute our findings in the future.
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Affiliation(s)
- Antonio Chuh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
| | - Vijay Zawar
- Department of Dermatology, Godavari Foundation Medical College and Research Center, DUPMCJ, India
| | - Gabriel F. Sciallis
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Werner Kempf
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Albert Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
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