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Mikulska M, Oltolini C, Zappulo E, Bartoletti M, Frustaci AM, Visentin A, Vitale C, Mauro FR. Prevention and management of infectious complications in patients with chronic lymphocytic leukemia (CLL) treated with BTK and BCL-2 inhibitors, focus on current guidelines. Blood Rev 2024; 65:101180. [PMID: 38331696 DOI: 10.1016/j.blre.2024.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
CLL is associated with an increased risk of infectious complications. Treatment with BTK or BCL-2 inhibitors does not seem to increase significantly the risk of opportunistic infections, but the role of combination therapies including BTK and/or BCL-2 inhibitors remains to be established. Various infectious complications can be successfully prevented with appropriate risk management strategies. In this paper we reviewed the international guidelines on prevention and management of infectious complications in patients with CLL treated with BTK or BCL-2 inhibitors. Universal pharmacological anti-herpes, antibacterial or antifungal prophylaxis is not warranted. Reactivation of HBV should be prevented in HBsAg-positive subjects. For HBsAg-negative/HBcAb-positive patients recommendations differ, but in case of combination treatment should follow those for other, particularly anti-CD20, agent. Immunization should be provided preferably before the onset of treatment. Immunoglobulin therapy has favourable impact on morbidity but not mortality in patients with hypogammaglobulinemia and severe or recurrent infections. Lack of high-quality data and heterogeneity of patients or protocols included in the studies might explain differences among the main guidelines. Better data collection is warranted.
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Affiliation(s)
- Malgorzata Mikulska
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | | | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele Milan, Italy; Infectious Disease Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Francesca R Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Niemeyer CS, Harlander-Locke M, Bubak AN, Rzasa-Lynn R, Birlea M. Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment. Curr Pain Headache Rep 2024; 28:295-306. [PMID: 38261232 PMCID: PMC10940365 DOI: 10.1007/s11916-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies. RECENT FINDINGS TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Harlander-Locke
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Charlier C, Anselem O, Caseris M, Lachâtre M, Tazi A, Driessen M, Pinquier D, Le Cœur C, Saunier A, Bergamelli M, Gibert Vanspranghels R, Chosidow A, Cazanave C, Alain S, Faure K, Birgy A, Dubos F, Lesprit P, Guinaud J, Cohen R, Decousser JW, Grimprel E, Huissoud C, Blanc J, Kayem G, Vuotto F, Vauloup-Fellous C. Prevention and management of VZV infection during pregnancy and the perinatal period. Infect Dis Now 2024; 54:104857. [PMID: 38311003 DOI: 10.1016/j.idnow.2024.104857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Caroline Charlier
- Université Paris Cité, Paris Centre University Hospital, Infectious Diseases Transversal Team, Infectious Diseases Department, AP-HP, FHU Prema, Paris, France; Institut Pasteur, French National Reference Center and WHO Collaborating Center Listeria, Biology of Infection Unit, Inserm U1117, Paris, France.
| | - Olivia Anselem
- Paris Centre University Hospital, Maternité Port-Royal AP-HP, FHU Prema, Paris, France
| | - Marion Caseris
- Robert Debré University Hospital, Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, AP-HP, Paris, France
| | - Marie Lachâtre
- Paris Centre University Hospital, Clinical Vaccinology Center, AP-HP, Paris, France
| | - Asmaa Tazi
- Université Paris Cité, Paris Centre University Hospital, Bacteriology Unit, French National Reference Center Streptococci, AP-HP, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Marine Driessen
- Necker Enfants University Hospital, Department of Obstetrics and Fetal Medicine, AP-HP, Paris, France
| | - Didier Pinquier
- CHU Rouen, Department of Neonatal and Pediatric Intensive Care Medicine, Normandie University, UNIROUEN, INSERM U1245, Rouen, France
| | - Chemsa Le Cœur
- Tours University Hospital, Infectious Diseases and Tropical Medicine Unit, Tours, France
| | - Aurélie Saunier
- Périgueux Hospital, Infectious Diseases Unit, Périgueux, France
| | - Mathilde Bergamelli
- Department of Clinical Sciences, Intervention and Technology (CLINTEC) Karolinska Institute, Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anaïs Chosidow
- CHI Villeneuve Saint Georges, Department of Pediatrics, Villeneuve Saint Georges, France
| | - Charles Cazanave
- CHU Bordeaux, Infectious and Tropical Diseases Department, Univ. Bordeaux, UMR 5234 CNRS, ARMYNE, Bordeaux, France
| | - Sophie Alain
- Microbiology Department, and Medical Genomic Unit CHU Limoges, UMR Inserm 1092, RESINFIT, Limoges University, IFR GEIST, Medical Faculty, National Reference Center for Herpesviruses, Centre de Biologie et de Recherche en Santé (CBRS) Limoges, France
| | - Karine Faure
- CHU Lille, Infectious Diseases Unit, Lille, France
| | - André Birgy
- Université Paris Cité, Robert Debré University Hospital, Microbiology Unit, AP-HP, IAME, UMR1137, INSERM, Paris, France
| | - François Dubos
- Université Lille, CHU Lille, Pediatric Emergency Unit & Infectious Diseases, ULR2694: METRICS, F-59000 Lille, France
| | | | - Julie Guinaud
- CHU La Réunion site sud, Neonatology and Neonatal Intensive Care Unit, Saint Pierre, France
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, CHI Créteil, Créteil, France
| | - Jean-Winoc Decousser
- Université Paris Est Créteil, Henri Mondor University Hospital EOH, AP-HP, Créteil, France
| | - Emmanuel Grimprel
- Service de pédiatrie générale et aval des urgences, hôpital Trousseau, Paris, APHP, Sorbonne Sorbonne Université Médecine, France
| | - Cyril Huissoud
- Hospices Civils de Lyon, Service de gynécologie obstétrique de l HFME, 59 Bd Pinel, 69500 Bron, Université Claude Bernard, Lyon 1, INSERM U1208, Stem-Cell and Brain Research Institute, France
| | - Julie Blanc
- Université de Marseille, Hôpital Nord University Hospital, Obstetrics Ward, Assistance Publique hôpitaux Marseille, Marseille, France
| | - Gilles Kayem
- Trousseau University Hospital, Obstetrics Ward, Assistance Publique - hôpitaux Paris, Sorbonne Université, FHU Prema, Paris, France
| | - Fanny Vuotto
- CHU Lille, Infectious Diseases Unit, Lille, France
| | - Christelle Vauloup-Fellous
- Division of Virology, WHO Rubella National Reference Laboratory, Dept of Biology Genetics and PUI, Paris Saclay University Hospital, APHP, Paris, France; Université Paris-Saclay, INSERM U1184, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses, France
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Niemeyer CS, Traina-Dorge V, Doyle-Meyers L, Das A, Looper J, Mescher T, Feia B, Medina E, Nagel MA, Mahalingam R, Bubak AN. Simian varicella virus infection and reactivation in rhesus macaques trigger cytokine and Aβ40/42 alterations in serum and cerebrospinal fluid. J Neurovirol 2024; 30:86-99. [PMID: 38453879 DOI: 10.1007/s13365-024-01196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
Simian varicella virus (SVV) produces peripheral inflammatory responses during varicella (primary infection) and zoster (reactivation) in rhesus macaques (RM). However, it is unclear if peripheral measures are accurate proxies for central nervous system (CNS) responses. Thus, we analyzed cytokine and Aβ42/Aβ40 changes in paired serum and cerebrospinal fluid (CSF) during the course of infection. During varicella and zoster, every RM had variable changes in serum and CSF cytokine and Aβ42/Aβ40 levels compared to pre-inoculation levels. Overall, peripheral infection appears to affect CNS cytokine and Aβ42/Aβ40 levels independent of serum responses, suggesting that peripheral disease may contribute to CNS disease.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Vicki Traina-Dorge
- Division of Microbiology, Tulane National Primate Research Center, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Lara Doyle-Meyers
- Division of Veterinary Medicine, Tulane National Primate Research Center, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Arpita Das
- Division of Microbiology, Tulane National Primate Research Center, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Jayme Looper
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Teresa Mescher
- Department of Psychiatry Behavioral Health and Wellness Program, University of Colorado School of Medicine, Aurora, Co, 80045, USA
| | - Brittany Feia
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Eva Medina
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Maria A Nagel
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Co, 80045, USA
| | - Ravi Mahalingam
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA.
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Shrestha AC, Field E, Rajmokan M, Lambert SB. Assessing the impact of chickenpox and shingles vaccination using intermittent enhanced surveillance in Queensland, Australia. Vaccine 2023; 41:7539-7547. [PMID: 37980260 DOI: 10.1016/j.vaccine.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Chickenpox and shingles are vaccine preventable diseases caused by varicella-zoster virus (VZV). Chickenpox is more common in children before adolescence and shingles among ≥50 years of age. With this study we aimed to determine changes in VZV epidemiology following chickenpox and shingles vaccine introduction in Queensland. METHODS This case series study used notified cases of VZV infection in Queensland from January 2010 to December 2021. In Queensland, VZV notifications are received as mostly clinically unspecified cases from pathology laboratories. Intermittent enhanced surveillance was conducted using clinician follow up to determine chickenpox and shingles clinical presentation, and we then analysed these by age-group, time period, and within vaccine eligible cohorts. RESULTS Of the 87,759 VZV notifications received, 70 % (n = 61,298) were notified as unspecified, followed by 23 % shingles (n = 19,927), and 7 % chickenpox (n = 6,534). Over the study period, the percent change in total notifications adjusted by age and sex was estimated to be an increase of 5.7 % (95 % CI 4.9-6.4) each year. The chickenpox notifications fell sharply at 18 months of age (eligible for chickenpox vaccine) with the rate being 57 % and 36 % lower among those aged 18-23 months compared to <12 and 12-17 months of age, respectively. Assuming all cases aged 60 years and older were shingles, notification rates of shingles decreased by 12-22 % among 70-79 years old (eligible for shingles vaccination) over the years 2017-2021 after vaccine introduction in 2016. CONCLUSION The VZV notification rate has increased over time in Queensland. Impact of chickenpox and shingles vaccines funded under National Immunisation Program is seen with a decline in notification rates among age-specific cohorts eligible to receive the vaccines under the program. Introduction of a second childhood dose chickenpox vaccine and more effective recombinant shingles vaccine may further improve the impact of the vaccination program.
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Affiliation(s)
- Ashish C Shrestha
- Communicable Diseases Branch, Queensland Health, Brisbane, QLD, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
| | - Emma Field
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
| | - Mohana Rajmokan
- Communicable Diseases Branch, Queensland Health, Brisbane, QLD, Australia.
| | - Stephen B Lambert
- Communicable Diseases Branch, Queensland Health, Brisbane, QLD, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
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Niemeyer CS, Traina-Dorge V, Doyle-Meyers L, Das A, Looper J, Mescher T, Feia B, Medina E, Nagel MA, Mahalingam R, Bubak AN. Simian Varicella Virus Infection and Reactivation in Rhesus Macaques Trigger Cytokine and Aβ40/42 Alterations in Serum and Cerebrospinal Fluid. Res Sq 2023:rs.3.rs-3367215. [PMID: 37886544 PMCID: PMC10602180 DOI: 10.21203/rs.3.rs-3367215/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Simian varicella virus (SVV) produces peripheral inflammatory responses during varicella (primary infection) and zoster (reactivation) in rhesus macaques (RM). However, it is unclear if peripheral measures are accurate proxies for central nervous system (CNS) responses. Thus, we analyzed cytokine and Aβ42/Aβ40 changes in paired serum and cerebrospinal fluid (CSF) during the course of infection. During varicella and zoster, every RM had variable changes in serum and CSF cytokine and Aβ42/Aβ40 levels compared to pre-inoculation levels. Overall, peripheral infection appears to affect CNS cytokine and Aβ42/Aβ40 levels independent of serum responses, suggesting that peripheral disease may contribute to CNS disease.
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Affiliation(s)
| | | | | | | | - Jayme Looper
- Louisiana State University School of Veterinary Medicine
| | - Teresa Mescher
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Brittany Feia
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Eva Medina
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Maria A Nagel
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Ravi Mahalingam
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Andrew N Bubak
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
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Shehadah A, Yousef A, Hashem A, Mahmoud AA, Aggarwal A. Bullous herpes zoster masquerading as a bullous pemphigoid flare: A case report. IDCases 2023; 33:e01846. [PMID: 37502653 PMCID: PMC10368929 DOI: 10.1016/j.idcr.2023.e01846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
Herpes zoster (HZ) results from the reactivation of dormant varicella zoster virus (VZV) in the posterior dorsal root ganglia manifesting as painful vesicles along the dermatomal distribution as shingles. The risk of reactivation is higher in immunocompromised patients. Herpes zoster lesions can have varied presentations including bullous forms, may induce BP flare, may co-exist in the same lesions, and should be included in the list of differentials for BP flares not responding to the standard of care. Here, we describe a case of a 74-year-old female with a history of recurrent bullous pemphigoid (BP) flares, who was on mycophenolate mofetil, and presented with skin lesions on her right thigh which were typical for her BP flares. Unlike prior flares, the lesions did not respond to prednisone therapy. Her hospitalization course was complicated by encephalopathy. Intravenous acyclovir was started empirically. Viral cultures and polymerase chain reaction from the lesions came back positive for VZV, but the patient succumbed to her illness shortly afterward.
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Affiliation(s)
- Ahmed Shehadah
- Department of Medicine, Rochester General Hospital, NY, USA
| | | | - Anas Hashem
- Department of Medicine, Rochester General Hospital, NY, USA
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Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Bouza E. Status of Herpes Zoster and Herpes Zoster Vaccines in 2023: A position paper. Rev Esp Quimioter 2023; 36:223-235. [PMID: 36752132 DOI: 10.37201/req/004.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Herpes zoster infection (HZ) is an important public health problem due to its high incidence and frequent complications, especially post-herpetic neuropathy . The incidence of HZ increases with age and is more frequent in immunocompromised patients. It is estimated that at least 60,000 people develop HZ each year in Spain. The usual forms of HZ are so clinically characteristic that they do not usually require microbiological confirmation, which is reserved for cases without cutaneous manifestations or with atypical presentation. There are currently two vaccines approved by the regulatory agencies and marketed in Spain to prevent the onset of HZ and its complications. The first (Zostavax®) was marketed by the company MSD and licensed in Europe in 2006 and is a live attenuated virus vaccine that is administered in a single dose, while the second (Shingrix®) is a recombinant vaccine, marketed in 2017 and requires two doses. While the former cannot be administered to immunocompromised persons, the latter can be prescribed to any group of adults. The criteria for the indication and financing of these vaccines have not been uniform in the various autonomous communities of Spain. These and other aspects of HZ have been discussed by a group of experts from the Illustrious Official College of Physicians of Madrid (ICOMEM) whose criteria and opinions are included in this paper.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Rasizadeh R, Shamekh A, Shiri Aghbash P, Bannazadeh Baghi H. Comparison of human monkeypox, chickenpox and smallpox: a comprehensive review of pathology and dermatological manifestations. Curr Med Res Opin 2023; 39:751-760. [PMID: 37025009 DOI: 10.1080/03007995.2023.2200122] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Variola virus, the causing agent of smallpox, was eradicated in 1980s and today no new cases are reported. The first human infectious illness to be eliminated globally is variola. On the contrary to Variola, monkeypox, which is a zoonotic and variola-like disease, has nowadays turned to be a major health problem worldwide. VZV is a neurotropic virus and the cause of varicella (chickenpox) and herpes zoster (shingles), which is also a highly infectious disease, especially prevalent in children. These three skin diseases-monkeypox, smallpox, and chickenpox-are frequently mistaken with one another due to similar manifestations including fever, rash, myalgia, chills and headache, but they can all be distinguished by their distinctive symptoms. Although these rash-causing disorders might present different skin lesions; diagnostic tests can be extremely useful in their differentiation. We searched for these concepts on a search engine like Google Scholar, scanning the results for alternative words and phrases, and examined relevant abstracts or articles for alternative words. The clinical diagnosis of monkeypox infection is commonly made based on the occurrence pattern of its skin rash. It is possible in varicella to concurrently identify lesions in their various stages including macular, papular, vesicular, pustular, and crusts; however, monkeypox lesions are all in the same stage and evolve with the same rate. In this review, we have tried to provide a holistic and comprehensive comparison between these three skin infections with a focus on the newly epidemic monkeypox, bringing about the most recent knowledge about its features and its diagnosis.
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Affiliation(s)
- Reyhaneh Rasizadeh
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Shamekh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parisa Shiri Aghbash
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Mok CC, Ho LY, Tse SM, Chan KL, To CH. Prevalence and risk factors of herpes zoster infection in patients with rheumatic diseases not receiving biologic or targeted therapies. Clin Rheumatol 2023; 42:1019-1026. [PMID: 36385600 DOI: 10.1007/s10067-022-06450-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective was to study the prevalence and risk factors of herpes zoster (HZ) infection in patients with rheumatic diseases. METHODS Consecutive patients with rheumatic diseases not receiving biologic/targeted DMARDs who attended our rheumatology clinics between March and August 2019 were retrospectively reviewed. Episodes of HZ infection since their first clinic attendance were identified. Laboratory results (total white cell count, neutrophil-to-lymphocyte ratio (NLR), serum albumin, globulin, and creatinine) and use of immunosuppressive medications were compared between those with (preceding infection) and without (preceding last visit) HZ infection. Cox regression analysis was performed to identify factors associated with the first HZ infection in all patients. RESULTS 1,479 patients were studied (88.3% women, age 45.0 ± 15.8 years). Systemic lupus erythematosus (SLE) (38.7%) and rheumatoid arthritis (28.3%) were the commonest rheumatic diseases. After a follow-up of 14,715 patient-years (9.9 ± 7.0 years), 219 (14.8%) patients developed 258 episodes of HZ infection, giving an overall prevalence of 1.75/100-patient years. The prevalence rates of HZ were highest in SLE and inflammatory myopathies (2.54 and 2.58 per 100 patient-years, respectively). Patients who experienced HZ reactivation were younger, more likely to have SLE, and had significantly lower serum albumin/globulin levels but higher NLR. Significantly more patients with HZ reactivation were using prednisolone and other immunosuppressive drugs in the visits preceding HZ infection. The cumulative risk of having HZ reactivation at 24 and 48 months was 4.9% and 7.6%, respectively. Cox regression analysis revealed that a diagnosis of SLE, increasing age, higher NLR, use of cyclophosphamide, and increasing doses of prednisolone, azathioprine, hydroxychloroquine and leflunomide were independently associated with HZ infection. CONCLUSIONS Reactivation of HZ is fairly common in patients with rheumatic diseases. Underlying SLE, age, neutrophil/lymphocyte ratio, and immunosuppressive therapies are independent risk factors. Key Points • Herpes zoster (HZ) infection is fairly common in patients with rheumatic diseases undergoing conventional DMARD or immunosuppressive therapies. • Underlying SLE, increasing age, higher neutrophil/lymphocyte ratio and increasing dosages of immunosuppressive drugs are independent risk factors. • Patients with rheumatic diseases, particularly SLE, should be encouraged to receive HZ vaccination.
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Affiliation(s)
- Chi Chiu Mok
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China.
| | - Ling Yin Ho
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
| | - Sau Mei Tse
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
| | - Kar Li Chan
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
| | - Chi Hung To
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
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11
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Leung J, Gray EB, Anderson TC, Sharkey SM, Dooling K. Recombinant zoster vaccine (RZV) second-dose series completion in adults aged 50-64 years in the United States. Vaccine 2022; 40:7187-7190. [PMID: 36347721 DOI: 10.1016/j.vaccine.2022.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/27/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
In 2018, CDC recommended a highly efficacious adjuvanted recombinant zoster vaccine (RZV) as a 2-dose series for prevention of herpes zoster (HZ) for immunocompetent persons age ≥ 50 years, with the 2nd dose recommended 2-6 months after the 1st dose. We estimated second-dose RZV series completion in the U.S. among 50-64-year-olds using two administrative databases. Second-dose RZV series completion was ∼70% within 6-months and 80% within 12-months of first dose. Among those who received only 1 RZV dose with at least 12 months of follow-up time, 96% had a missed opportunity for a second-dose vaccination, defined as a provider or pharmacy visit, among whom 36% had a visit for influenza or pneumococcal vaccination within 2-12 months of their first-dose of RZV. We found that RZV series completion rates in 50-64-year-olds was high. Availability of RZV at pharmacies has potentially helped increase series completion, but missed opportunities remain.
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Affiliation(s)
- Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Elizabeth B Gray
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tara C Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah M Sharkey
- IQVIA Government Solutions, Information and Analytics, Atlanta, GA, United States
| | - Kathleen Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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12
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Coyle DT. Trigeminal Zoster with drug-induced labial angioedema leading to necrosis. Med Pharm Rep 2022; 95:467-470. [PMID: 36506612 PMCID: PMC9694752 DOI: 10.15386/mpr-2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/27/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Zoster is caused by the reactivation of a dormant viral infection, and is characterized by painful, vesicular lesions along a dermatome. Neuritic pain associated with zoster can be treated with anticonvulsant medications. Case Report An immunocompetent adult physician developed prominent zoster lesions in the trigeminal nerve distribution. Treatment included antiviral therapy for the acute infection, and pharmacotherapy for neuritic pain. Pharmacotherapy included several anticonvulsant agents, with labial angioedema developing after initiation of oxcarbazepine. Discussion The case is notable for the pictorial timeline of lesion development, as well as the marked incident angioedema following initiation of treatment for neuritis with oxcarbazepine. Conclusions Clinicians should remain vigilant for drug-induced facial angioedema when treating patients with trigeminal zoster-related neuritis due to the potential for angioedema to aggravate a lesion, resulting in scarring. Angioedema of the head and neck should be closely monitored due to the potential for airway compromise.
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Affiliation(s)
- David Tyler Coyle
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, CO 80045, USA
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13
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Chevet B, Figueroa-Parra G, Yang JX, Hocaoglu M, Osei-Onomah SA, Hulshizer CA, Gunderson TM, Cornec D, Barbour KE, Greenlund KJ, Crowson CS, Duarte-García A. Utilization of preventive services in a systemic lupus erythematosus population-based cohort: a Lupus Midwest Network (LUMEN) study. Arthritis Res Ther 2022; 24:211. [PMID: 36050780 PMCID: PMC9434086 DOI: 10.1186/s13075-022-02878-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a disease that can lead to damage of multiple organs and, along with certain treatments, increase the risk of developing cancer, cardiovascular disease, diabetes, osteoporosis, and infections. Preventive services are particularly important in patients with SLE to mitigate the aforementioned risks. We aimed to evaluate the trends of preventive services utilization in patients with systemic lupus erythematosus, compared with non-SLE population. METHODS All ≥19-year-old patients in the Lupus Midwest Network (LUMEN) registry, a population-based cohort, with SLE on January 1, 2015, were included and matched (1:1) by sex, age, race, and county to non-SLE comparators. Among both groups, we compared the rates of screenings for breast and cervical cancer, hypertension, hyperlipidemia, diabetes mellitus, and osteoporosis as well as immunizations. RESULTS We included 440 SLE patients and 430 non-SLE comparators. The probability of breast cancer screening among women with SLE was similar to comparators (hazard ratio [HR] 1.09, 95% CI 0.85-1.39), while cervical cancer screening was lower (HR 0.75, 95% CI 0.58-0.96). Hypertension screening was higher among patients with SLE (HR 1.35, 95% CI 1.13-1.62); however, hyperlipidemia screening was similar to comparators (HR 1.16, 95% CI 0.96-1.41). Diabetes and osteoporosis screenings were more likely to be performed for SLE patients than for comparators (HR 2.46, 95% CI 2.11-2.87; and HR 3.19, 95% CI 2.31-4.41; respectively). Influenza and pneumococcal immunizations were higher among SLE patients (HR 1.31, 95% CI 1.12-1.54; and HR 2.06, 95% CI 1.38-3.09; respectively), while zoster vaccination was similar (HR 1.17, 95% CI 0.81-1.69). CONCLUSIONS The trends of utilization of preventive services by SLE patients vary according to screening or vaccine compared with the general population. Considering these differences, we demonstrate an opportunity for improvement, particularly in cervical cancer, hyperlipidemia, and osteoporosis screenings and vaccinations.
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Affiliation(s)
- Baptiste Chevet
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
- Division of Rheumatology, Brest Teaching Hospital; LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | | | - Jeffrey X Yang
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mehmet Hocaoglu
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
| | | | | | - Tina M Gunderson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Divi Cornec
- Division of Rheumatology, Brest Teaching Hospital; LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA.
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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14
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Meyer JJ, Liu K, Danesh-Meyer HV, Niederer RL. Prompt antiviral therapy is associated with lower risk of cerebrovascular accident following herpes zoster ophthalmicus. Am J Ophthalmol 2022; 242:215-220. [PMID: 35809660 DOI: 10.1016/j.ajo.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine risk factors associated with cerebrovascular accident (CVA) following herpes zoster ophthalmicus (HZO). DESIGN Retrospective cohort study METHODS: : Review of medical records of all subjects with HZO seen at the department of Ophthalmology, Auckland District Health Board, New Zealand, between 1st January 2006 and 31st December 2016. MAIN OUTCOME MEASURES Cerebrovascular accident within 12 months of diagnosis. RESULTS 869 patients diagnosed with HZO were included in the study. The median age at onset of HZO was 65.5 (Interquartile range, IQR 52.9 - 75.4) and 52.5% (n=456) were male. Antiviral therapy was started in 765 participants (88.0%), not utilised in 95 (10.9%) and not documented in 9 participants (1.0%). Four hundred sixty-eight participants (54.9%) received prompt oral antiviral therapy (≤72 hours of rash onset). A CVA occurred in the 12 months following HZO in 14 subjects (1.6%) and was most common in older subjects, occurring in 2.5% aged ≥65 years, 0.7% aged 40-65 years and 0.9% aged <40 years. Hazard of CVA was highest immediately following HZO, with median time to CVA of 2.3 months (IQR 0.8 - 5.9 months). Subjects that received prompt acyclovir had a 76.2% lower hazard of CVA (0.9% vs 2.6%, p=0.022) on multivariate analysis. CONCLUSIONS Cerebrovascular accident occurs in a low proportion of individuals within one year following HZO. Antiviral treatment for HZO may reduce the risk of subsequent CVA when given within 72 hours of rash onset.
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Affiliation(s)
- Jay J Meyer
- University of Auckland, Department of Ophthalmology, Private Bag 92019, Auckland 1142, New Zealand
| | - Kevin Liu
- University of Auckland, Department of Ophthalmology, Private Bag 92019, Auckland 1142, New Zealand
| | - Helen V Danesh-Meyer
- University of Auckland, Department of Ophthalmology, Private Bag 92019, Auckland 1142, New Zealand
| | - Rachael L Niederer
- University of Auckland, Department of Ophthalmology, Private Bag 92019, Auckland 1142, New Zealand.
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15
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Seirafianpour F, Pourriyahi H, Mesgarha MG, Pour Mohammad A, Shaka Z, Goodarzi A. A systematic review on mucocutaneous presentations after COVD-19 vaccination and expert recommendations about vaccination of important immune-mediated dermatologic disorders. Dermatol Ther 2022; 35:e15461. [PMID: 35316551 PMCID: PMC9111423 DOI: 10.1111/dth.15461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
With dermatologic side effects being fairly prevalent following vaccination against COVID-19, and the multitude of studies aiming to report and analyze these adverse events, the need for an extensive investigation on previous studies seemed urgent,in order to provide a thorough body of information about these post-COVID-19 immunization mucocutaneous reactions. To achieve this goal, a comprehensive electronic search was performed through the international databases including Medline (PubMed), Scopus, Cochrane, Web of science, and Google scholar on July 12, 2021, and all articles regarding mucocutaneous manifestations and considerations after COVID-19 vaccine administration were retrieved using the following keywords: COVID-19 vaccine, dermatology considerations and mucocutaneous manifestations. A total of 917 records were retrieved and a final number of 180 articles were included in data extraction. Mild, moderate, severe and potentially life-threatening adverse events have been reported following immunization with COVID vaccines, through case reports, case series, observational studies, randomized clinical trials, and further recommendations and consensus position papers regarding vaccination. In this systematic review, we categorized these results in detail into five elaborate tables, making what we believe to be an extensively informative, unprecedented set of data on this topic. Based on our findings, in the viewpoint of the pros and cons of vaccination, mucocutaneous adverse events were mostly non-significant, self-limiting reactions, and for the more uncommon moderate to severe reactions, guidelines and consensus position papers could be of great importance to provide those at higher risks and those with specific worries of flare-ups or inefficient immunization, with sufficient recommendations to safely schedule their vaccine doses, or avoid vaccination if they have the discussed contra-indications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Farnoosh Seirafianpour
- Student Research Committee, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Homa Pourriyahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Arash Pour Mohammad
- Student Research Committee, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zoha Shaka
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
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16
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Abstract
Epidemiologic data regarding the risk of Guillain-Barré syndrome (GBS) following herpes zoster (HZ) are limited. We conducted a self-controlled case series analysis using two large national data sources to evaluate the risk of GBS following HZ among U.S. adults. We analyzed medical claims from the IBM® MarketScan® Commercial Claims and Encounters (persons 18-64 years during 2010-2018) and Centers for Medicare and Medicaid Services Medicare (persons ≥65 years during 2014-2018) databases. HZ cases were defined as persons with an outpatient claim with a primary or secondary ICD-9 or ICD-10 diagnostic code for HZ. GBS cases were defined as persons with an inpatient claim with a principle diagnostic code for GBS and an associated procedural code. We compared the rates of GBS following HZ in the 1-42-day risk window versus primary (100-365-day) or secondary (43-99-day) control windows. We identified 489,516 persons 18-64 years of age and 650,229 persons ≥65 years of age with HZ, among whom 11 and 41, respectively, developed GBS 1-365 days following HZ. The risk of GBS following HZ was increased during the risk window as compared to the primary control window for both groups, with a rate ratio of 6.3 (95% CI, 1.8-21.9) for those 18-64 years and 4.1 (95% CI, 1.9-8.7) for those ≥65 years. This study provides new and methodologically rigorous epidemiologic support for an association between HZ and GBS, and useful context regarding the benefits versus potential risks of zoster vaccination.
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Affiliation(s)
- Tara C Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica W Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kathleen L Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Gorgani FM, Beyer TL. Neurotrophic corneal ulcer and iridocyclitis directly preceding Ramsay-Hunt Syndrome. Am J Ophthalmol Case Rep 2021; 24:101220. [PMID: 34786517 DOI: 10.1016/j.ajoc.2021.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 07/24/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To present to and inform the practitioner of an unusual presentation of Varicella zoster virus and Ramsay-Hunt Syndrome. Observations A 69-year-old bedbound male with vascular dementia presented to the emergency room with a red right eye with associated tearing and mucus production. The patient could not express if he was in pain. The initial diagnosis from the emergency room was bacterial keratitis, confirmed with a positive pseudomonas culture. However, upon examination by the ophthalmologist it was noted that there was not only a large, infected epithelial defect, but also an intraocular pressure of 35 and a candy-cane hypopyon. The diagnosis of herpes neurotrophic keratitis and iridocyclitis was made and the patient was started on intravenous acyclovir along with the appropriate topical medications. A day later, it was noted that the patient developed a right sided facial palsy and vesicular lesions inside the right ear canal, as confirmed by otolaryngology. Conclusion and Importance Ramsay-Hunt Syndrome is usually known to the ophthalmologist due to the exposure keratopathy caused by facial palsy. This case demonstrates varicella-zoster virus (VZV) neurotrophic keratitis preceding the development of facial palsy, which can further exacerbate an already neurotrophic cornea. The practitioner should be aware of these signs and symptoms and adjust their treatment with systemic acyclovir-prednisone.
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18
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Abu-Rumeileh S, Mayer B, Still V, Tumani H, Otto M, Senel M. Varicella zoster virus-induced neurological disease after COVID-19 vaccination: a retrospective monocentric study. J Neurol 2021. [PMID: 34724572 DOI: 10.1007/s00415-021-10849-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 10/27/2022]
Abstract
The description of every possible adverse effect or event related to vaccines is mandatory during the ongoing worldwide COVID-19 vaccination program. Although cases of cutaneous varicella zoster virus (VZV) reactivation after COVID-19 vaccination have been increasingly reported in literature and database sets, a description of VZV-induced neurological disease (VZV-ND) is still lacking. In the present study, we retrospectively evaluated patients admitted to our clinic and diagnosed with VZV-ND during the COVID-19 vaccination campaign (January-April 2021) and in the same months in the previous two years. We identified three patients with VZV-ND after COVID-19 vaccination and 19 unvaccinated VZV-ND cases as controls. In the case-control analysis, the two groups showed no difference in clinical features, results of diagnostic investigations, and outcome. Thus, VZV reactivation with neurological involvement might be a possible event triggered by COVID-19 vaccination, but the benefit following COVID-19 vaccination overcomes significantly the potential risk associated with a VZV reactivation.
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19
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Sahra S, Jahangir A, Glaser A, Mobarakai N, Jahangir A. Case report: aseptic meningitis secondary to varicella- zoster virus (VZV) without an exanthem post MMR vaccination. BMC Infect Dis 2021; 21:746. [PMID: 34344345 PMCID: PMC8330204 DOI: 10.1186/s12879-021-06453-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Varicella-zoster virus (VZV) is a known cause of aseptic meningitis, with a predisposition for an immunocompromised population. A dermatomal rash usually accompanies aseptic meningitis secondary to VZV. CASE PRESENTATION We report the case of a 31-year-old male with a history of chickenpox in childhood and recent shingles who presented with severe frontal headaches secondary to VZV meningitis. The patient had also recently received the measles-mumps-rubella (MMR) vaccine. He recovered without any neurological sequala. CONCLUSION This case report describes an immunocompetent patient with recent MMR vaccination who developed aseptic meningitis secondary to VZV without any dermatomal involvement (Zoster Sine Herpete).
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Affiliation(s)
- Syeda Sahra
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA.
| | - Abdullah Jahangir
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA
| | - Allison Glaser
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA
| | - Neville Mobarakai
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA
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20
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Arora P, Sardana K, Mathachan SR, Malhotra P. Herpes zoster after inactivated COVID-19 vaccine: A cutaneous adverse effect of the vaccine. J Cosmet Dermatol 2021; 20:3389-3390. [PMID: 34077622 PMCID: PMC8242496 DOI: 10.1111/jocd.14268] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Pooja Arora
- Dr Ram Manohar Lohia Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
| | - Kabir Sardana
- Dr Ram Manohar Lohia Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
| | - Sinu Rose Mathachan
- Dr Ram Manohar Lohia Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
| | - Purnima Malhotra
- Dr Ram Manohar Lohia Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India
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21
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Shah R, Amador C, Tormanen K, Ghiam S, Saghizadeh M, Arumugaswami V, Kumar A, Kramerov AA, Ljubimov AV. Systemic diseases and the cornea. Exp Eye Res 2021; 204:108455. [PMID: 33485845 PMCID: PMC7946758 DOI: 10.1016/j.exer.2021.108455] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
There is a number of systemic diseases affecting the cornea. These include endocrine disorders (diabetes, Graves' disease, Addison's disease, hyperparathyroidism), infections with viruses (SARS-CoV-2, herpes simplex, varicella zoster, HTLV-1, Epstein-Barr virus) and bacteria (tuberculosis, syphilis and Pseudomonas aeruginosa), autoimmune and inflammatory diseases (rheumatoid arthritis, Sjögren's syndrome, lupus erythematosus, gout, atopic and vernal keratoconjunctivitis, multiple sclerosis, granulomatosis with polyangiitis, sarcoidosis, Cogan's syndrome, immunobullous diseases), corneal deposit disorders (Wilson's disease, cystinosis, Fabry disease, Meretoja's syndrome, mucopolysaccharidosis, hyperlipoproteinemia), and genetic disorders (aniridia, Ehlers-Danlos syndromes, Marfan syndrome). Corneal manifestations often provide an insight to underlying systemic diseases and can act as the first indicator of an undiagnosed systemic condition. Routine eye exams can bring attention to potentially life-threatening illnesses. In this review, we provide a fairly detailed overview of the pathologic changes in the cornea described in various systemic diseases and also discuss underlying molecular mechanisms, as well as current and emerging treatments.
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Affiliation(s)
- Ruchi Shah
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Cynthia Amador
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kati Tormanen
- Center for Neurobiology and Vaccine Development, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Ghiam
- Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Mehrnoosh Saghizadeh
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vaithi Arumugaswami
- Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Andrei A Kramerov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander V Ljubimov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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22
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Abstract
Background Herpes zoster (HZ) also known as shingles is a common dermatological pathology seen in the emergency department. Multidermatomal involvement is an uncommon presentation and usually is linked to immunocompromised individuals. However, it is rarely reported in the immunocompetent population. Case presentation We report a 30-year-old Emirati male complaining of low-grade fever for 3 days, sore throat and an uncomfortable pruritic erythematous rash over his chest and back for 2 days. He was treated the day preceding his presentation in another facility for a presumed allergic reaction after taking ibuprofen. On physical examination, he was found to have exudative tonsillitis and influenza and was treated for both and discharged. He returned to the emergency department reporting increasing pain and was referred to be seen in the dermatology clinic where a biopsy was obtained, and he was discharged with a steroid topical cream. Fourteen days later, he returned to the clinic reporting crusting of the rash; the biopsy results were positive for herpes zoster. The diagnosis of multidermatomal herpes zoster was made, and he was then treated with antivirals. Conclusions Herpes zoster can present with atypical manifestations. Multidermatomal HZ is a rare dermatological manifestation in the immunocompetent adult. It is characterised by a rash spread over two or more adjacent dermatomes. This case highlights the challenging diagnosis of this dermatological presentation.
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Affiliation(s)
| | | | - Sabrina Berdouk
- Sheikh Khalifah Medical City, Abu Dhabi, United Arab Emirates
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23
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Santos DH, Carneiro de Oliveira RDM, Junior WRF, Olivetti BC. Myelorradiculitis due to Varicella Zoster (Elsberg syndrome) as the first symptom of HIV in a patient with Crohn's disease in use of Infliximab. Mult Scler Relat Disord 2020; 47:102643. [PMID: 33310420 DOI: 10.1016/j.msard.2020.102643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
Elsberg syndrome (ES) refers to the combination of myelitis and lumbosacral radiculitis associated with infection caused by the virus of the Herpesviridae family. We present a case of a 52-year-old man with a 9 months diagnosis of Crohn's disease, in use of infliximab with good disease control, complaining of 2 months history of progressive urinary retention and loss of sensation of the genital and left lower limb regions associated with varicella zoster virus (VZV) infection and recent HIV diagnosis.
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Affiliation(s)
- Diogo Haddad Santos
- Department of Neurology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Neurology, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Devilliers MJ, Ben Hadj Salah W, Barreau E, Da Cunha E, M'Garrech M, Bénichou J, Labetoulle M, Rousseau A. [Ocular manifestations of viral diseases]. Rev Med Interne 2020; 42:401-410. [PMID: 33168354 PMCID: PMC7646372 DOI: 10.1016/j.revmed.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/07/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023]
Abstract
Les infections virales peuvent toucher l’ensemble des tuniques oculaires et mettre en jeu la fonction visuelle à plus ou moins courte terme. Les kératites et kérato-uvéites liées au virus HSV-1 sont les atteintes les plus fréquentes. Les récurrences entraînent une opacification cornéenne irréversible qui en fait la première cause de cécité d’origine infectieuse dans les pays occidentaux, et justifient un traitement antiviral préventif au long cours. Le zona ophtalmique (10 à 20 % des zonas), peut s’accompagner d’atteintes oculaires sévères (kératites, kérato-uvéites), dont 30 % deviennent chroniques/récurrentes, et de douleurs post-zostériennes, redoutables dans le territoire trigéminé. Les rétinites nécrosantes liées aux herpesvirus (HSV, VZV, CMV), sont rares mais constituent des urgences fonctionnelles absolues nécessitant un traitement antiviral par voie intraveineuse et intravitréenne. Les conjonctivites à adénovirus constituent la première cause de conjonctivite infectieuse. Le plus souvent bénignes, elles sont extrêmement contagieuses et peuvent se compliquer de lésions cornéennes invalidantes persistant plusieurs mois, voire années. Certaines arboviroses s’accompagnent de manifestations oculaires inflammatoires. Dans le cas du Zika, les infections congénitales peuvent se compliquer d’atrophie maculaire et/ou optique. Les conjonctivites sont très fréquentes à la phase aiguë de la maladie à virus Ebola, dont 15 % des survivants présentent des atteintes inflammatoires chroniques sévères liées à la persistance du virus dans les tissus uvéaux. Enfin, dans le cadre de la COVID-19, les conjonctivites ne sont pas très fréquentes mais peuvent être inaugurales, voire au premier plan et sont associées à une excrétion virale lacrymale qui doit faire prendre toutes les précautions.
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Affiliation(s)
- M-J Devilliers
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - W Ben Hadj Salah
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - E Barreau
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - E Da Cunha
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - M M'Garrech
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - J Bénichou
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - M Labetoulle
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Département d'immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB/IDMIT) CEA, Fontenay-aux-Roses, France
| | - A Rousseau
- Service d'ophtalmologie, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, CRMR OPHTARA (maladies rares en ophtalmologie), 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France; Département d'immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB/IDMIT) CEA, Fontenay-aux-Roses, France.
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Bubak AN, Traina-Dorge V, Como CN, Feia B, Pearce CM, Doyle-Meyers L, Das A, Looper J, Mahalingam R, Nagel MA. Elevated serum substance P during simian varicella virus infection in rhesus macaques: implications for chronic inflammation and adverse cerebrovascular events. J Neurovirol 2020; 26:945-51. [PMID: 32964407 DOI: 10.1007/s13365-020-00907-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 01/16/2023]
Abstract
Varicella and zoster, produced by varicella-zoster virus (VZV), are associated with an increased risk of stroke that may be due to persistent inflammation and hypercoagulability. Because substance P is associated with inflammation, hypercoagulability, and atherosclerotic plaque rupture that may contribute to increased stroke risk after VZV infection, we measured serum substance P in simian varicella virus-infected rhesus macaques. We found significantly increased and persistent serum substance P concentrations during varicella and zoster compared with pre-inoculation, supporting the hypothesis that VZV-induced increases in serum substance P may contribute to increased stroke risk associated with VZV infection.
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Mok CC, Tse SM, Chan KL, Ho LY. Prevalence and risk factors of herpes zoster infection in patients with biopsy proven lupus nephritis undergoing immunosuppressive therapies. Lupus 2020; 29:836-844. [PMID: 32408851 DOI: 10.1177/0961203320923739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To study the prevalence of herpes zoster infection in patients with biopsy-confirmed lupus nephritis undergoing immunosuppressive therapies. METHODS Patients who had histologically active lupus nephritis between 2004 and 2018 were retrospectively reviewed. Clinical and laboratory data at baseline and six months post-therapy were collected. The incidence of herpes zoster reactivation within two years of lupus nephritis treatment was calculated. Risk factors for herpes zoster reactivation were studied by logistic regression. RESULTS Patients (N = 251) with 311 episodes of lupus nephritis were studied (92% women; age 34.2 ± 14.2 years; histological classes III/IV ± V (69%)). Within two years of therapy, 55 (18%) episodes of lupus nephritis were complicated by herpes zoster infection (incidence 8.84/100 patient-years). Fourteen episodes (25%) of herpes zoster were treated by intravenous anti-viral drugs in hospital but disseminated disease or mortality was not reported. Significant post-herpetic neuralgia developed in 9% of the episodes. Patients with herpes zoster reactivation, compared with those without, were more likely to have first-time renal disease and a shorter systemic lupus erythematosus duration at lupus nephritis than those without. Disease activity, treatment response and other clinical/laboratory parameters were not significantly different between patients with and without herpes zoster reactivation. Herpes zoster-infected patients had been treated with a significantly higher dose of prednisolone as induction therapy. Logistic regression revealed that first-time renal disease, peak daily mycophenolate mofetil dose and cumulative cyclophosphamide dose during induction therapy were significantly associated with herpes zoster reactivation. CONCLUSIONS Herpes zoster reactivation is common in lupus nephritis patients but unpredictable from clinical parameters. Although adverse outcomes of herpes zoster infection are uncommon, using the minimally effective doses of mycophenolate mofetil and cyclophosphamide during induction therapy may help reduce the risk of herpes zoster infection.
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Affiliation(s)
- Chi Chiu Mok
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong, SAR China
| | - Sau Mei Tse
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong, SAR China
| | - Kar Li Chan
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong, SAR China
| | - Ling Yin Ho
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong, SAR China
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Murthy NK, Sharma M, Spinner RJ. Primary peripheral nerve tumors associated with nerve-territory herpes zoster. Acta Neurochir (Wien) 2020; 162:1147-51. [PMID: 32193725 DOI: 10.1007/s00701-020-04292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
Herpes viruses have been described as markers of occult cancer and have also been implicated in oncogenesis. This group of viruses includes varicella-zoster virus (VZV) which is well-known for its ability to evade the immune response by lying dormant in the dorsal root ganglion of peripheral nerves. Although it is common knowledge that VZV reactivation causes herpes zoster (shingles), there have been no reports in literature of herpes zoster manifesting in the dermatomal territory of peripheral nerves involved by either benign or malignant tumors. We report two cases of patients with peripheral nerve tumors who presented with herpes zoster in the dermatomal distribution of the involved nerves. One patient had primary neurolymphomatosis, whereas the other had a sacral schwannoma. We believe these are the first cases to be reported that demonstrate herpes zoster at clinical presentation in patients with peripheral nerve tumors. This suggests that VZV may have the potential to cause peripheral nerve tumors via a complex interplay of viral oncogenes and alterations in host immunological responses.
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Kunz HE, Makedonas G, Mehta SK, Tyring SK, Vangipuram R, Quiriarte H, Nelman-Gonzalez M, Pierson DL, Crucian BE. Zoster patients on earth and astronauts in space share similar immunologic profiles. Life Sci Space Res (Amst) 2020; 25:119-128. [PMID: 32414485 DOI: 10.1016/j.lssr.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/25/2019] [Accepted: 10/09/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND On long-duration spaceflight, most astronauts experience persistent immune dysregulation and the reactivation of latent herpesviruses, including varicella zoster virus (VZV). To understand the clinical risk of these perturbations to astronauts, we paralleled the immunology and virology work-up of astronauts to otherwise healthy terrestrial persons with acute herpes zoster. METHODS Blood samples from 42 zoster patients - confirmed positive by PCR for VZV DNA in saliva (range from 100 to >285 million copies/mL) were analyzed for peripheral leukocyte distribution, T cell function, and plasma cytokine profiles via multi-parametric flow cytometry and multiplex bead-based immune-array assays. Patient findings were compared to normal value ranges specific for each assay that were defined in-house previously from healthy adult test subjects. RESULTS Compared to the healthy adult ranges, the zoster patients possess (1) a higher proportion of constitutively activated T-cells, (2) a T-cell population skewed towards a more experienced maturation state, (3) depressed general T-cell function, and (4) a higher concentration of 20 of 22 measured plasma cytokines. DISCUSSION The pattern of immune dysregulation in zoster patients is similar to that of astronauts during spaceflight who shed VZV DNA in their saliva. Because future deep space exploration missions will be of an unprecedented duration, prolonged immune depression and chronic viral reactivation threaten to manifest overt disease in exploration class astronauts.
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Affiliation(s)
| | | | | | - Stephen K Tyring
- University of Texas Houston Health Sciences Center, Houston, TX, United States
| | - Ramya Vangipuram
- University of Texas Houston Health Sciences Center, Houston, TX, United States
| | | | | | - Duane L Pierson
- NASA Johnson Space Center, 2101 E NASA Pkwy, Houston, TX 77058, United States
| | - Brian E Crucian
- NASA Johnson Space Center, 2101 E NASA Pkwy, Houston, TX 77058, United States.
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Abstract
The herpes zoster (shingles) vaccine is recommended for all adults aged ≥ 60 years without contraindications to prevent shingles and post-herpetic neuralgia. There are no published studies on zoster vaccination rates, barriers, or workflows in adults who have experienced homelessness. Due to barriers specific to this vaccine, including difficulty determining insurance coverage, high upfront costs, need for storage in a freezer, and under-prescription by physicians, uptake is lower compared to other recommended vaccines for older adults. To address these barriers, we developed a new approach of partnering our on-site primary care clinic in a transitional homeless shelter with a local pharmacy and offering vaccination on Shingles Immunization Days with a goal of matching or exceeding the national zoster immunization rate of 30.6%. Over a 3-year period, the live attenuated zoster vaccine was offered to 86% of eligible patients resulting in an immunization rate of 38.1%. This is higher than the estimated national rate but significantly lower than rates of tetanus (80.6%), pneumococcal (76.3%), and influenza (69.6%) vaccination in the same population, highlighting the unique obstacles to zoster immunization. Major reasons that patients were not immunized included lack of insurance coverage and patient refusal of all vaccines. Our findings demonstrate that homeless adults are interested in zoster vaccination and a model of on-site primary care in a shelter partnering with a pharmacy can successfully improve vaccine uptake in this population. Coverage of the new inactivated zoster vaccine under Medicare Part B could increase the national zoster immunization rate.
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Affiliation(s)
- Laura Kaplan-Weisman
- Institute for Family Health, New York, NY, USA.
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Suite L5-40, New York, NY, 10029, USA.
- Care for the Homeless, New York, NY, USA.
| | - Eve Waltermaurer
- Institute for Family Health, New York, NY, USA
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Suite L5-40, New York, NY, 10029, USA
| | - Casey Crump
- Institute for Family Health, New York, NY, USA
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Suite L5-40, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Harpaz R. Do varicella vaccination programs change the epidemiology of herpes zoster? A comprehensive review, with focus on the United States. Expert Rev Vaccines 2019; 18:793-811. [PMID: 31318605 DOI: 10.1080/14760584.2019.1646129] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Policy-makers in many countries have been wary of introducing varicella vaccination programs because of concerns that reduced exposures to varicella-zoster virus could increase herpes zoster (HZ) incidence. The U.S. introduced varicella vaccination in 1996 and has empiric evidence regarding this concern. Areas covered: This comprehensive review provides background emphasizing the epidemiology of varicella and of HZ in the U.S. before and after the introduction of their respective vaccines. The epidemiology is complex, and interpretation is complicated by methodologic challenges, by unexplained increases in age-specific HZ incidence that preceded varicella vaccination, and by introduction of vaccines for prevention of HZ. Nonetheless, observations from studies using different platforms and designs have yielded consistent findings, suggesting they are robust. Expert opinion: There has been no evidence that the U.S. varicella vaccination program increased HZ incidence in the general adult population over baseline trends. Furthermore, HZ incidence in children is declining. The U.S. experience can inform the development of new generations of models to predict HZ trends. More importantly, it provides reassurance for countries considering varicella vaccination that an effective program can reduce varicella morbidity and mortality while reducing the likelihood of HZ among children, and potentially, over time, across the entire population.
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Affiliation(s)
- Rafael Harpaz
- a Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Meyers JL, Candrilli SD, Rausch DA, Yan S, Patterson BJ, Levin MJ. Costs of herpes zoster complications in older adults: A cohort study of US claims database. Vaccine 2019; 37:1235-1244. [PMID: 30685248 DOI: 10.1016/j.vaccine.2018.11.079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND/OBJECTIVES Herpes zoster (HZ) incidence increases with age, and the burden of HZ is expected to grow with aging of populations worldwide. We aim to determine the incremental healthcare resource utilization and associated costs of patients with common HZ-related complications other than postherpetic neuralgia (cutaneous, neurologic and ophthalmic) compared to uncomplicated HZ. METHODS We conducted a retrospective cohort study of commercial health insurance claims covering about 40 million immunocompetent individuals aged ≥50 years at study entry from all over the US, from 2008 to 2013, with follow-up for one year after HZ onset. All-cause healthcare resource utilization and direct healthcare costs were recorded and calculated from six months before until 12 months after HZ onset. The mean costs for HZ patients with complications were compared to the mean costs for patients with uncomplicated HZ. Multivariable regression analyses estimated mean incremental costs adjusted for demographics, comorbidities, type of complication and time period. RESULTS Over the five-year study period, 22,948 HZ patients (60% women, median age 62 years) who experienced at least one of the selected complications were compared to 213,232 patients (63% women, median age 61 years) with uncomplicated HZ. Overall, the mean annual incremental unadjusted costs for the patients with HZ-related complications were US$4716, ranging from US$2173 for ophthalmic to US$18,323 for neurologic complications. Most of the incremental costs associated with HZ complications were accrued during the first quarter after HZ onset. For each complication type the incremental costs increased with age up to, but not including the oldest group, aged ≥80 years. CONCLUSIONS Approximately 10% of immunocompetent older patients with HZ develop complications which considerably increase the economic burden of HZ. Vaccination of older adults will offset some of the burden of HZ, including costs associated with HZ-related complications.
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Affiliation(s)
- Juliana L Meyers
- RTI Health Solutions, Research Triangle Park, NC, United States.
| | - Sean D Candrilli
- RTI Health Solutions, Research Triangle Park, NC, United States.
| | | | | | | | - Myron J Levin
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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Deviley JA, Oldenburg D, Berg LC, Agger WA. Recurrent strokes, central nervous system vasculitis, and acquired protein S deficiency secondary to varicella zoster in a child with AIDS. J Neurovirol 2018; 25:137-140. [PMID: 30478796 DOI: 10.1007/s13365-018-0697-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 12/21/2022]
Abstract
A child with vertical transmission of human immunodeficiency virus refractory to therapy developed zoster-induced protein S deficiency and recurrent strokes. Extensive carotid arteritis was found postmortem. The carotid tissue was positive for herpes varicella zoster by polymerase chain reaction, as were immunofixation stains of the arterial wall.
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Affiliation(s)
- Jake A Deviley
- Department of Medical Research, Gundersen Health System, Mail Stop C03-006B, 1836 South Avenue, La Crosse, WI, 54601, USA
| | - Darby Oldenburg
- Department of Medical Research, Gundersen Health System, Mail Stop C03-006B, 1836 South Avenue, La Crosse, WI, 54601, USA
| | - Laurence C Berg
- Department of Pathology, Gundersen Health System, La Crosse, WI, USA
| | - William A Agger
- Department of Medical Research, Gundersen Health System, Mail Stop C03-006B, 1836 South Avenue, La Crosse, WI, 54601, USA. .,Department of Infectious Disease, Gundersen Health System, La Crosse, WI, USA.
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Abstract
PURPOSE OF REVIEW Patients with inflammatory bowel disease (IBD) are at increased risk of infectious diseases independent of their immunosuppression status, and yet, studies suggest that this population is not receiving standard vaccinations at the same rate as the general population. This review seeks to understand why IBD patients may not be receiving recommended immunizations and to provide guidelines on vaccinating this vulnerable population. RECENT FINDINGS Inactive vaccines are recommended for patients with IBD regardless of immunosuppression status due to the increased risk for many vaccine-preventable illnesses. Certain live vaccines can be administered to the immunocompromised patient with IBD. Additionally, many patients with IBD will be immunosuppressed some time in their disease course, further increasing their risk for infection. Despite this understanding, patients with IBD have poor vaccination rates. Inadequate knowledge, limited time with patients, and lack of consensus as to who is responsible for identifying and administering vaccinations are some of the most important barriers to vaccinating the patient with IBD. In this review, we discuss guidelines for vaccinating both the immunocompetent and immunosuppressed patient with IBD as well as provide vaccine-specific recommendations. The evidence suggests that patients with IBD are not receiving recommended vaccinations because of misconceptions on the part of patients as well as a paucity of knowledge by their health care team. Educational programs can be successfully implemented to increase knowledge about appropriate vaccinations and can ultimately increase vaccine uptake among patients with IBD. In the end, gastroenterologists and primary care physicians must work together with their patients with IBD to ensure that recommended vaccinations are administered.
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Affiliation(s)
- Jennifer Coukos
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Francis A Farraye
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, 85 East Concord Street, Boston, MA, 02118, USA.
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Abstract
Herpes zoster (HZ) is the result of reactivation of latent varicella zoster virus (VZV) and occurs most frequently in older adults. Classically, HZ presents as a unilateral, selflimited, dermatomal rash. Postherpetic neuralgia (PHN) is a common sequela, presenting as severe pain that persists after the rash has resolved. In the elderly, PHN can be debilitating and requires a prompt diagnosis, treatment with antivirals, and adequate pain control. A longer-term pain management strategy is required if PHN occurs. A modestly effective vaccine exists and is recommended for older individuals.
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Freer G, Pistello M. Varicella- zoster virus infection: natural history, clinical manifestations, immunity and current and future vaccination strategies. New Microbiol 2018; 41:95-105. [PMID: 29498740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
Varicella-zoster virus (VZV) is the etiologic agent of varicella (chicken pox), a childhood exanthematic disease that develops as a result of primary infection, and zoster (shingles), caused by reactivation of the virus persisting in a latent form in the dorsal sensory ganglia. Although varicella is generally a mild self-limiting illness, in immunocompromised subjects and adults it can have a serious clinical course that can lead to permanent damage of the central nervous system. In these and in most zoster cases, treatment with anti-herpetic drugs and/or immunotherapy is necessary. Because it is highly contagious, varicella is one of the most common exanthematic diseases. It is preventable by vaccination with an attenuated vaccine administered around the first year of age, and with a boost vaccination in school age. This article briefly describes the natural history and pathophysiology of VZV infection and its current epidemiology and provides an overview of current and future vaccine options to protect against varicella and/or zoster.
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Affiliation(s)
- Giulia Freer
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa
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Hussey H, Abdullahi L, Collins J, Muloiwa R, Hussey G, Kagina B. Varicella zoster virus-associated morbidity and mortality in Africa - a systematic review. BMC Infect Dis 2017; 17:717. [PMID: 29137604 PMCID: PMC5686819 DOI: 10.1186/s12879-017-2815-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 11/02/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) causes varicella and herpes zoster. These vaccine preventable diseases are common globally. Most available data on VZV epidemiology are from industrialised temperate countries and cannot be used to guide decisions on the immunization policy against VZV in Africa. This systematic review aims to review the published data on VZV morbidity and mortality in Africa. METHODS All published studies conducted in Africa from 1974 to 2015 were eligible. Eligible studies must have reported any VZV epidemiological measure (incidence, prevalence, hospitalization rate and mortality rate). For inclusion in the review, studies must have used a defined VZV case definition, be it clinical or laboratory-based. RESULTS Twenty articles from 13 African countries were included in the review. Most included studies were cross-sectional, conducted on hospitalized patients, and half of the studies used varying serological methods for diagnosis. VZV seroprevalence was very high among adults. Limited data on VZV seroprevalence in children showed very low seropositivity to anti-VZV antibodies. Co-morbidity with VZV was common. CONCLUSION There is lack of quality data that could be used to develop VZV control programmes, including vaccination, in Africa. TRIAL REGISTRATION PROSPERO 2015: CRD42015026144 .
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Affiliation(s)
- Hannah Hussey
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leila Abdullahi
- Vaccines for Africa Initiative, Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jamie Collins
- Department of Biostatistics, School of Public Health, Harvard Medical School, Boston, MA USA
| | - Rudzani Muloiwa
- Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory Hussey
- Vaccines for Africa Initiative, Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin Kagina
- Vaccines for Africa Initiative, Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Vaccines for Africa Initiative, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Manouchehrinia A, Tanasescu R, Kareem H, Jerca OP, Jabeen F, Shafei R, Breuer J, Neal K, Irving W, Constantinescu CS. Prevalence of a history of prior varicella/herpes zoster infection in multiple sclerosis. J Neurovirol 2017; 23:839-44. [PMID: 28895088 DOI: 10.1007/s13365-017-0569-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/29/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022]
Abstract
Varicella zoster virus (VZV) infection has been implicated in multiple sclerosis (MS), but direct causal involvement has been disputed. Nevertheless, knowledge of VZV exposure is important, given the risk of serious complications of first exposure while undergoing immunosuppressive treatment, in particular with fingolimod. We distributed questionnaires to MS clinic patients, requesting information about history of chickenpox, sibling/household/occupational exposure, history of zoster (shingles), and disease-modifying treatment. A random, proportionally representative sample of 51 patients that included patients with positive, negative, and unknown chickenpox history were selected for determination of VZV IgG by ELISA. Of 1206 distributed questionnaires, 605 were returned (50% response rate). Of these, 86% reported history of chickenpox, 5.6% gave negative history, and 8.5% did not know. Of 594 who answered the zoster question, 78% gave a negative response, 4% did not know, and 104 (17%) answered yes. Of these, 83 reported 1 episode; 12 had 2; 5 had 3; and 1 each reported 5, 6, and 15 episodes. Of 51 patients tested for VZV IgG (44 "yes," 4 "no," and 3 "I don't know" answers to the question of whether they had chickenpox), 48 were seropositive; the 3 seronegative all had reported having had chickenpox. The high rate of MS patients reporting prior chickenpox infection is comparable with previous reports. A substantial proportion of MS patients, estimated to be higher than an age-matched general population, report single or multiple episodes of zoster. These data are useful for consideration of immunosuppressive treatments and/or VZV and zoster vaccination.
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Hechter RC, Qian L, Yan S, Luo Y, Krishnarajah G, Tseng HF. Impact of the change of copay policy in Medicare Part D on zoster vaccine uptake among Medicare beneficiaries in a managed care organization. BMC Health Serv Res 2017; 17:503. [PMID: 28732518 PMCID: PMC5521141 DOI: 10.1186/s12913-017-2441-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Kaiser Permanente Southern California (KPSC) adopted the Medicare Part D Tier-6 with zero patient copay for zoster vaccination in 2012. We assessed the impact of the implementation on zoster vaccination rate (GSK study identifier: HO-13-14,182). Methods Zoster vaccination rate was examined among an open cohort of ≥65-year-old Medicare Part D beneficiaries during 01/01/2008–06/30/2014, compared to ≥65-year-old commercial health plan members and 60–64-year-old members. The demographics, vaccination records, and insurance and benefit type were confirmed through KPSC electronic medical record databases. Person-time based vaccination rate was calculated for each observation interval (calendar month or year). The changes in annual rates in one year pre- (2011) and post- (2012) Tier-6 implementation were compared in a difference-in-difference analysis. Linear spline Poisson regression models were fitted to compare the secular trend of monthly rates during pre and post Tier-6 implementation (01/2012). Results Zoster vaccination rate increased in Medicare Part D beneficiaries after the implementation of zero copay. The increase in annual vaccination rate from 2011 to 2012 was marginally higher in Medicare Part D beneficiaries but not statistically significant (difference in rate ratio [RR] = 0.04, p > 0.05) compared to commercial health plan members. Among non-Hispanic white members, the difference of RR was 0.09 (p = 0.020) between Medicare Part D beneficiaries and ≥65-year-old commercial plan members, and it was 0.08 (p = 0.034) compared to 60–64-year-old commercial plan members. In secular trend analysis, we did not observe significant increase in overall and race stratified zoster vaccination rate attributable to the implementation of the Tier-6. Conclusions The impact of Tier-6 on zoster vaccination was not substantial in elderly Medicare Part D beneficiaries in this population where a lower than average copay ($20 to $40) was applied prior to the Tier-6 implementation. Further research is necessary to explore the numerical relationship between vaccination and amount of copay. Trial registration GSK study identifier: HO-13-14,182. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2441-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rulin C Hechter
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA
| | - Songkai Yan
- US Health Outcomes & Epidemiology - Vaccines, GSK, 5 Crescent Drive, Philadelphia, PA, 19112, USA.,CSL Behring, 1020 First Avenue, King of Prussia, PA, 19406, USA
| | - Yi Luo
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA
| | - Girishanthy Krishnarajah
- US Health Outcomes & Epidemiology - Vaccines, GSK, 5 Crescent Drive, Philadelphia, PA, 19112, USA.,CSL Behring, 1020 First Avenue, King of Prussia, PA, 19406, USA
| | - Hung-Fu Tseng
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA.
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Abstract
Varicella and zoster continue to cause significant morbidity and even mortality in children and adults. Complications include bacterial superinfection, central nervous system manifestations such as meningitis, encephalitis, and cerebellar ataxia, and pain syndromes especially post herpetic neuralgia. Many developed countries but not all, are now administering live attenuated varicella vaccine routinely, with a decrease in the incidence of disease, providing personal and herd immunity. There is some controversy, however, in some countries concerning whether a decrease in the circulation of wild type virus will result in loss of immunity to VZV in persons who have already had varicella. This manuscript reviews the complications of varicella and zoster in detail, the reasons for development of vaccines against these diseases, complications of vaccinations, and mechanisms by which immunity to this virus develops and is maintained. There are strong indications that the best way to control disease and spread of this virus is by vaccination against both.
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Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
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Luisier V, Weber L, Fishman D, Praz G, Ghika JA, Genoud D, Chabwine JN. Definition and management of varicella zoster virus-associated meningoradiculitis: a case report. BMC Res Notes 2016; 9:451. [PMID: 27670683 PMCID: PMC5037650 DOI: 10.1186/s13104-016-2257-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The varicella zoster virus affects the central or peripheral nervous systems upon reactivation, especially when cell-mediated immunity is impaired. Among varicella zoster virus-related neurological syndromes, meningoradiculitis is an ill-defined condition for which clear management guidelines are still lacking. Zoster paresis is usually considered to be a varicella zoster virus-peripheral nervous system complication and treated with oral antiviral therapy. Yet in the literature, the few reported cases of herpes zoster with mild cerebral spinal fluid inflammation were all considered meningoradiculitis and treated using intravenous antiviral drugs, despite absence of systemic signs of meningitis. Nevertheless, these two clinical pictures are very similar. Case presentation We report the case of an alcohol-dependent elderly Caucasian man presenting with left lower limb zoster paresis and mild cerebral spinal fluid inflammation, with favorable outcome upon IV antiviral treatment. We discuss interpretation of liquor inflammation in the absence of clinical meningitis and implications for the antiviral treatment route. Conclusion From this case report we suggest that varicella zoster virus-associated meningoradiculitis should necessarily include meningitis symptoms with the peripheral neurological deficits and cerebral spinal fluid inflammation, requiring intravenous antiviral treatment. In the absence of (cell-mediated) immunosuppression, isolated zoster paresis does not necessitate spinal tap or intravenous antiviral therapy.
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Affiliation(s)
- Vincent Luisier
- Internal Medicine Division, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Lalensia Weber
- Internal Medicine Division, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Daniel Fishman
- Emergency Department, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Gérard Praz
- Infectious Disease Division (Central Institute), Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Joseph-André Ghika
- Division of Neurology, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Didier Genoud
- Division of Neurology, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Joelle Nsimire Chabwine
- Division of Neurology, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland. .,Neurology Unit, Department of Medicine, Faculty of Sciences, University of Fribourg, Chemin du Musée 5, 1700, Fribourg, Switzerland.
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Abstract
Varicella zoster virus (VZV) is a highly neurotropic human herpesvirus. Primary infection usually causes varicella (chicken pox), after which virus becomes latent in ganglionic neurons along the entire neuraxis. VZV reactivation results in zoster (shingles) which is frequently complicated by chronic pain (postherpetic neuralgia). VZV reactivation also causes meningoencephalitis, myelitis, ocular disorders, and vasculopathy, all of which can occur in the absence of rash. This review focuses on the association of VZV and stroke, and on the widening spectrum of disorders produced by VZV vasculopathy in immunocompetent and immunocompromised individuals, including recipients of varicella vaccine. Aside from ischemic stroke, VZV infection of cerebral arteries may lead to development of intracerebral aneurysms, with or without hemorrhage. Moreover, recent clinical-virological case reports and retrospective pathological-virological analyses of temporal arteries positive or negative for giant cell arteritis (GCA) indicate that extracranial VZV vasculopathy triggers the immunopathology of GCA. While many patients with GCA improve after corticosteroid treatment, prolonged corticosteroid use may potentiate VZV infection, leading to fatal vasculopathy in the brain and other organs.
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Albert K, Masset M, Bonnet S, Willermain F, Caspers L. Long-term follow-up of herpetic non-necrotizing retinopathy with occlusive retinal vasculitis and neovascularization. J Ophthalmic Inflamm Infect 2015; 5:6. [PMID: 25861397 PMCID: PMC4385048 DOI: 10.1186/s12348-015-0038-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 02/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background Herpetic necrotizing retinitis is a well-recognized entity. A few cases of herpetic non-necrotizing retinitis were previously reported. Findings We retrospectively report two cases of herpetic non-necrotizing retinopathy with a long follow-up. A 19-year-old woman presented with a bilateral diffuse occlusive retinal vasculitis, peripheral neovascularization, and no signs of retinal necrosis. Long-lasting immunosuppressive treatment failed to control the vasculitis until herpes simplex virus type 1 (HSV1) was demonstrated by polymerase chain reaction (PCR) in the aqueous. Acyclovir was then added and immunosuppressive tapered and eventually stopped resulting in a resolution of vasculitis. Only two relapses occurred during the next 6 years and responded rapidly to oral acyclovir. An 11-year-old boy presented with unilateral scar of stromal keratitis, severe vitritis, and optic disc neovascularization, followed 6 weeks later by peripheral occlusive retinal vasculitis. Therapeutic and diagnostic vitrectomy was performed, and PCR was found to be positive for varicella zoster virus (VZV) in a vitreous specimen. The inflammation responded to oral acyclovir therapy. Recurrence of anterior uveitis with iris depigmentation occurred 4 months after treatment was arrested. After 4 years, he presented again with a recurrence of anterior inflammation and cystoid macular edema (CME). No sign of inflammation was seen for the next 10 years. Conclusions These rare cases support the possible role of herpes viruses (HSV or VZV) in occlusive vasculitis without retinal necrosis. PCR was useful to raise the diagnosis and to adapt the treatment. A good response was obtained on oral antiviral therapy.
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Affiliation(s)
- Kim Albert
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium ; Centre Hospitalier Universitaire Brugmann, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium
| | - Maureen Masset
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium ; Centre Hospitalier Universitaire Brugmann, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium
| | - Sabine Bonnet
- Department of Ophthalmology, Centre Hospitalier Regional de la Citadelle, Boulevard du 12ème de Ligne 1, 4000 Liège, Belgium
| | - François Willermain
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium ; Centre Hospitalier Universitaire Brugmann, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium
| | - Laure Caspers
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Rue Haute 322, 1000 Brussels, Belgium ; Centre Hospitalier Universitaire Brugmann, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium
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Gurel MS, Savas S, Bilgin F, Erdil D, Leblebici C, Sarikaya E. Zosteriform pemphigoid after zoster: Wolf's isotopic response. Int Wound J 2015; 13:141-2. [PMID: 25659195 DOI: 10.1111/iwj.12423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/11/2015] [Indexed: 11/30/2022] Open
Abstract
The Wolf isotopic response describes the occurrence of a new, unrelated disease that appears at the same location as a previously healed disease. The most common primary skin disorder of this phenomenon is herpes zoster and less frequently, herpes simplex. We report a case of 79-year-old woman who have bullous pemphigoid (BP) with dermatomal distribution that developed at the site of previously healed herpes zoster. Based on clinical, histological and immunofluorescence findings, the patient was diagnosed with localized BP in a site of prior herpes zoster. BP developing at the site of healed herpes zoster is the first reported case. Recognition of this phenomenon is important for correct clinicopathologic diagnosis and may improve our understanding of the underlying pathophysiologic processes.
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Affiliation(s)
- Mehmet S Gurel
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sevil Savas
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Fusun Bilgin
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Duygu Erdil
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ebru Sarikaya
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
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Abstract
Vaccines play a key role in the prevention of illness in the elderly, are cost effective, and generally safe. Hepatitis C, cirrhosis, autoimmune hepatitis, and inflammatory bowel disease are more prevalent than ever among older adults. Along with an age-related decline in immune system function (immunosenescence), these diseases make elderly individuals more susceptible to infections and more likely to experience a poor outcome relative to their younger counterparts. Vaccinations also appear to be less effective in the elderly, warranting research into different vaccination strategies such as booster vaccines, higher doses of vaccine, and measurement of antibody titers to guide vaccination.
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Affiliation(s)
- Henry A Horton
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Chettiar A. Management of primary care issues common to CKD and ESRD patients: a brief primer for the nephrology provider. Adv Chronic Kidney Dis 2014; 21:371-6. [PMID: 24969390 DOI: 10.1053/j.ackd.2014.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/11/2022]
Abstract
This article provides a brief overview of the diagnosis and management of selected primary care issues that are common to CKD and ESRD patients. The elements of diagnosis and management unique to kidney patients and controversies and updates in management will be presented. The topics reviewed are neuropathy, pruritus, zoster, hyperuricemia, gout, and gastroparesis.
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Teodoro T, Nagel MA, Geraldes R, White T, Mahalingam R, Batista P, Wellish M, Pimentel J, Khmeleva N, Heintzman A, Albuquerque L, Boyer PJ, Choe A, Peralta R, Gilden D. Biopsy-negative, varicella zoster virus (VZV)-positive giant cell arteritis, zoster, VZV encephalitis and ischemic optic neuropathy, all in one. J Neurol Sci 2014; 343:195-7. [PMID: 24923742 DOI: 10.1016/j.jns.2014.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/08/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
A 72-year-old man developed clinical features of giant cell arteritis (GCA) and ipsilateral ophthalmic-distribution zoster, followed within 2 weeks by VZV encephalitis and 2 months later by ischemic optic neuropathy. Temporal artery biopsy was histopathologically negative for GCA, but contained VZV antigen and VZV DNA in multiple non-contiguous (skip) areas. The collective clinical and laboratory findings revealed a remarkably close temporal association of zoster, multifocal VZV vasculopathy with temporal artery infection, biopsy-negative VZV-positive GCA and VZV encephalitis.
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Affiliation(s)
- Tiago Teodoro
- Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal
| | - Maria A Nagel
- Department of Neuropathology, Hospital de Santa Maria, Lisbon, Portugal
| | - Ruth Geraldes
- Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal
| | - Teresa White
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ravi Mahalingam
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paulo Batista
- Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal
| | - Mary Wellish
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jose Pimentel
- Department of Neuropathology, Hospital de Santa Maria, Lisbon, Portugal
| | - Nelly Khmeleva
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anna Heintzman
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Philip J Boyer
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander Choe
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rita Peralta
- Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal
| | - Don Gilden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Microbiology, University of Colorado School of Medicine, Aurora, CO, USA.
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Boivin G, Jovey R, Elliott CT, Patrick DM. Management and prevention of herpes zoster: A Canadian perspective. Can J Infect Dis Med Microbiol 2010; 21:45-52. [PMID: 21358885 DOI: 10.1155/2010/178036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Varicella-zoster virus reactivation leads to herpes zoster - the main complication of which is postherpetic neuralgia (PHN). Rapid antiviral therapy initiated within 72 h of rash onset has been shown to accelerate rash healing, reduce the duration of acute pain and, to some extent, attenuate the development and duration of PHN. Other adjunctive therapies such as analgesics, antidepressants and some anticonvulsants are frequently required in the management of severe PHN. A live, attenuated zoster vaccine has been recently shown to significantly decrease herpes zoster incidence, PHN and the overall burden of illness when administered to adults older than 60 years of age. This new prophylactic modality has been reported to be cost-effective in the Canadian context, especially in the 60- to 75-year-old age group.
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