Complications of chicken-pox

Effect of age on viral infections: possible role of interferon

In both experimental animals and humans, three stages of susceptibility to viral infections are apparent: 1) the neonatal state, characterized by enhanced susceptibility to infections; 2) childhood and adolescence, during which there is decreased susceptibility; and 3) adulthood (sexual maturity), characterized by increased susceptibility to primary viral infections with advancing age. Moreover, advanced age is associated with reactivation of latent viruses, most notably VZV, and, most likely, oncogenic viruses as well. The mechanisms responsible for these alterations in susceptibility to viral infections have not been completely elucidated. Differences in antibody production do not seem to play a role. Most authors feel that depression of cell-mediated immunity, as measured by delayed cutaneous hypersensitivity or lymphocyte stimulation by mitogens and antigens may be of importance. There have been, however, only few studies on the role of antiviral moieties, such as the interferon(s). Our data on interferon formation in response to coxsackievirus B3 infection in mice suggest that adult mice produce relatively less interferon in relation to the amount of virus replicated in their tissues than do younger animals. Furthermore, the absolute amount of interferon produced by adult animals in response to intravenous injection of (non-replicating virus) NDV was less than that found in younger mice. We report our studies on interferon with no implication that these data supply an adequate explanation for the greater vulnerability of adult mice infected with coxsackievirus B3. It is unlikely that the matter of age and susceptibility has interferon (or indeed any other factor) as a single determinant.(ABSTRACT TRUNCATED AT 250 WORDS)

Mielite pós-varicela

Os autores relatam um caso de mielopatia pós-varicela, realçando a pouca freqüência desta manifestação. A evolução foi favorável. O traçado eletrencefalográfico evidenciou ondas de sofrimento cerebral embora o paciente não apresentasse manifestações clínicas encefálicas. Os autores conseguiram coletar na literatura disponível apenas 20 casos semelhantes.

Para-infectious and post-vaccinal encephalomyelitis

The incidence of encephalomyelitis in association with acute specific fevers and prophylactic inoculations is discussed. Available statistics are inaccurate, but these conditions are of considerable importance—it is likely that there are about 400 cases of measles encephalitis in England and Wales in an epidemic year.

The pathology of these neurological complications is discussed and emphasis placed on the distinction between typical perivenous demyelinating encephalitis, and the toxic type of encephalopathy which occurs mainly in young children.

The clinical syndromes occurring in association with measles, chickenpox and German measles are considered. Although encephalitis is the most frequent complication, myelitis and polyradiculitis also occur. There is evidence that ‘uncomplicated measles’ is associated with brain involvement in the prodromal phase. Similar para-infectious disorders occur in association with other infections including smallpox and influenza.

The post-vaccinal types of encephalomyelitis are also considered with particular reference to post-vaccinial encephalitis and rabies post-vaccinal encephalitis.

The pathogenesis of these disorders is discussed and it is concluded that there is direct viral invasion of the nervous system, followed by an antigen-antibody reaction. At times virus may remain latent within the nerve cell without destroying it.

Ruptured spleen associated with chicken-pox

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Varicella pneumonitis

Four adults had varicella pneumonitis. All developed respiratory symptoms within a week of the exanthem. Cough and/or dyspnea, cyanosis and chest pain were common. Radiological signs of disease were more marked than physical signs. A slight polymorphonuclear leukocytosis and normal sputum culture were usual. One man with mild symptoms recovered. Two women, one pregnant, had severe symptoms and died. A second man succumbed to secondary bacterial pneumonia. The lungs in fatal cases showed interstitial pneumonitis with mononuclear cell infiltrate, focal areas of necrosis, and acidophilic inclusion bodies in two cases. Patients received oxygen, antibiotics and, in one instance, corticosteroid therapy. The value of antibiotics and corticosteroid treatment is questionable. Use of gamma globulin in preventing varicella pneumonitis is mentioned and residual pulmonary changes are discussed.