Case Of Varicella Zoster Virus Research Articles

Computed tomography manifestations of a case of varicella zoster virus (VZV) pneumonia.

Disseminated VZV infections is rare in healthy adults. Several studies have reported VZV reactivation and eruption happens in an immunocompromised host especially after solid organ transplantation. Nonetheless, diffuse bilateral lung VZV infections is also rare. We report a case of disseminated VZV pneumonia after renal transplantation and methylprednisolone treatment. This report highlights the computed tomography manifestations of disseminated VZV pneumonia.

Spatio-Temporal Attributes of Varicella-Zoster Case Number Trends Assist with Optimizing Machine Learning Predictions

The varicella-zoster virus (VZV) (chickenpox) is a problematic infectious disease with regular outbreaks occurring seasonally in most countries. Being able to predict with accuracy the expected number of cases in future weeks based on historical case trend information is an important goal both locally and nationally. Space and time-related attributes extracted from the case number trends for the previous 12 weeks of historical VZV cases recorded in Hungary. These attributes are able to generate reliable predictions for expected VZV cases for multiple weeks ahead. Supervised machine learning (SML) combined with feature selection optimizers can identify combinations of the most effective of 15 local trend time-series attributes supported. These features are complemented with an additional 10 regional trend attributes providing the spatial dimension. The most practical combination of influential trend attributes varies depending on the number of weeks ahead being forecast. SML models are developed using weekly VZV case data (2005–2014) for the regions of Hungary focusing on the region of Komarom-Esztergom (Kom) northwest of Budapest. SML predictions for up to 4 weeks ahead are most strongly influenced by the local time-series attributes including moving averages (MAs) and seasonality components from recently past weeks. However, for predictions further forward (up to 13 weeks) the SML models also exploit regional trend attributes related to recent past rate-of-change in VZV case numbers to provide effective predictions. The proposed trend-attribute method provides more accurate case predictions than the commonly used univariate case-forecasting methods relying on MA and autoregressive integrated moving models. The applied method also provides a means of data mining the most influential trend attributes and the time ranges of their effectiveness. The flexibility and transparency of the technique provide a robust method that could be applied for forecasting short-term epidemiological case numbers associated with other infectious diseases.

First detection of Varicella Zoster Virus clade 9 cases in India during mpox surveillance

Background The multi-country mpox outbreak across the globe has led to the systematic surveillance of mpox cases in India. During the surveillance of mpox, we encountered cases of Varicella Zoster Virus (VZV) in suspected mpox cases amongst children & adults. This study focused on the genomic characterization of VZV in India. Methods A total of 331 mpox suspected cases were tested for VZV through real-time PCR, and the positive samples were subjected to next-generation sequencing to retrieve the whole genome of VZV using CLC genomics software. Phylogenetic analysis has been done in MEGA 11.0 software to identify circulating clades. Result Of the 331 suspected cases, 28 cases with vesicular rashes were found to be positive for VZV. The maximum genome could be retrieved from the clinical specimens of 16 cases with coverage greater than 98% when mapped with reference strain Dumas (NC 001348). The phylogenetic analyses of these sequences determined the circulation of clades 1, 5, and 9 in India. Further, the sequence analysis demonstrated non-synonymous single nucleotide polymorphism (SNPs) among specific ORF of VZV including ORF 14, ORF 22, ORF 36, ORF 37 and ORF 51. Although clade 1 and 5 has been reported earlier, the circulation of clade 9 of VZV has been determined for the first time in India. Conclusion Although the circulation of different clades of VZV was reported from India, the presence of clade 9 was detected for the first time during the mpox surveillance.

Pole-to-pole involvement of varicella zoster virus reactivation following COVID-19 vaccination.

The aim of this study is to report the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management outcomes in a series of three cases of varicella zoster virus (VZV) reactivation following one dose of coronavirus disease 2019 (COVID-19) vaccination. This was a retrospective and observational study. All the patients who developed uveitis post-vaccination were pooled together. Patients who had VZV reactivation were included. Two cases had polymerase chain reaction positive for VZV from aqueous humor. At the time of presentation, IgG and IgM spike protein antibodies for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were tested. Out of this pool, three patients with classical features to describe pole-to-pole manifestations were chosen. A 36-year-old lady with post-vaccination sclerokeratouveitis associated with reactivation of herpes zoster ophthalmicus, a 56-year-old lady with post-vaccination acute anterior uveitis associated with herpes zoster ophthalmicus, and a 43-year-old gentleman with post-vaccination acute retinal necrosis were included. We present a possible link between anti-SARS-CoV-2 virus vaccination and varicella zoster reactivation in these patients and also describe the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management with detailed discussion.

317 - A rare case of varicella zoster virus in a 4-month old male

317 - A rare case of varicella zoster virus in a 4-month old male

Herpetic Eye Disease Following the SARS-CoV-2 Vaccinations

ABSTRACT Purpose To describe herpetic ocular infections following SARS-CoV-2 vaccinations. Methods A retrospective study of herpetic ocular infections after BNT162b2mRNA vaccination and a literature review. Results A cohort of five patients: three varicella zoster virus (VZV) and two herpes simplex virus (HSV) cases, as well as 19 literature cases: 9 cases of VZV and 10 cases of HSV post BNT162b2mRNA, AZD1222, mRNA-1273, and CoronaVac vaccinations. All cases presented within 28 days post vaccination. Most VZV and HSV cases (15/19) reported in the literature presented post first vaccine dose, while in our cohort 2 VZV cases presented post second dose and both HSV cases and one VZV case post third dose. The most common presentations were HZO with ocular involvement and HSV keratitis. All eyes had complete resolution; however, one had retinal detachment and three corneal scars. Conclusion Herpetic ocular infections may develop shortly after SARS-CoV-2 vaccinations. Overall, the outcome is good.

Varicella Zoster Reactivation Post COVID-19 Vaccination: Two Case Reports

Background: After initiation of COVID-19 vaccination, many side effects were described (Itching, swelling, pain, redness, induration, coughing, fatigue, fever, diarrhea, nausea, headache, vomiting, pruritus, myalgias, arthralgias, anorexia, malaise). Whether traditional, vector-based, or mRNA-based, all COVID-19 vaccines have had many mild and severe adverse events. In this article, we describe two cases of Varicella-Zoster Virus (VZV) reactivation one day after receiving Pfizer’s mRNA-based vaccine first dose, and another one month after the second dose. Both patients were not immunodeficient and not on immunomodulator therapy. To our knowledge, few similar cases have been described in the literature before, and thus it would be an important addition to guide future expectations and management in morbid patients receiving the mRNA vaccine for COVID-19. Case presentation: Case one is a 74-year-old male who presented with zoster reactivation one day after receiving the first mRNA COVID-19 vaccine. He was treated successfully with valacyclovir. The second case is an 83-year-old lady who presented with facial zoster reactivation one month post the second dose of the mentioned vaccine and was also treated with oral valacyclovir. Conclusion: The patients were not immunodeficient and not on immunomodulatory therapy, which is a major difference from the other reported cases, which are already few in the literature. To our knowledge, very few similar cases have been described in the literature before. Reporting more of such rare side effects would be of utmost importance to establish a full side effect profile of mRNA vaccines and to better understand such clinical finding. It is worth noting, however, that despite the risks that accompany these vaccines, the benefits far outweigh them.

690. Oka-Strain Varicella-Zoster Virus Meningitis in a Healthy Adolescent

BackgroundRoutine vaccination with varicella-zoster (VZV) vaccine has resulted in significant declines in the incidence of VZV cases, hospitalizations, and deaths across pediatric age. This vaccine is safe and effective and adverse events are monitored closely.MethodsWe describe a case of vOka meningoencephalitis in a twelve-year-old vaccinated boy who presented with altered mental status and a vesicular facial rash.ResultsA twelve-year-old healthy, fully-vaccinated boy presented to urgent care clnic with left-sided frontotemporal headache, left-sided eye pain, and photosensitivity. Over several days, a left-sided facial rash progressed to include papular and vesicular lesions over the cheek, as well as over the left side of the chin and at the midline of the lower lip. He was somnolent, sleeping 18- 20 hours a day. The child was evaluated by a pediatric neurologist who noted a left-sided ptosis and left lateral rectus palsy; he was admitted for further workup. Cerebrospinal fluid (CSF) analysis showed WBC of 33 cells/ml3 with 92% lymphocytes; glucose of 44mg/dL (serum glucose 84mg/dL), and protein of 50mg/dL (range: 15-45). Nasopharyngeal multiplex polymerase chain reaction (PCR) (BioFire Diagnostics, Salt Lake City, Utah) was positive for rhinovirus/enterovirus. Testing of facial vesicles for varicella-zoster virus (VZV) and herpes simplex virus (HSV) was negative by DFA and culture, and enteroviral throat and rectal PCRs were negative. However, CSF PCR for VZV was found to be positive. In light of this finding, the viral isolate was sent to Dr. Anne Gershon’s research lab at Columbia University Medical Center for typing and was determined to be vOka. Quantitative and functional immune studies were performed, and were normal. The patient initially received 7 days of intravenous acyclovir, during which time his rash resolved and mental status returned to baseline. He completed a total of 14 days of acyclovir and has had no recurrences.ConclusionThis case represents only the tenth case of Oka-strain meningitis in an immunocompetent child reported to date, and one of very few cases in immunocompetent adolescents. While rare, vOka meningitis is an entity of which primary care pediatricians and infectious diseases specialists should be aware, even in older children.Disclosures All Authors: No reported disclosures

Identification of pathogens in the vitreous of patients with infectious uveitis by metagenomic sequencing

Objective: To investigate the role of metagenomic sequencing in the diagnosis of infectious uveitis. Methods: Cross-sectional study. A total of 19 vitreous specimens of patients with suspected infectious uveitis from March 2016 to July 2018 in Beijing Tongren Hospital were collected, including 8 males and 11 females, 19 to 68 years old. There were 10 cases in the right eye, 8 cases in the left eye and 1 case in both eyes. Acute retinal necrosis was clinically diagnosed in 8 patients (9 eyes), and the diagnosis was unknown in 11 patients (11 eyes). About 1 ml of the vitreous fluid was reserved for each specimen, 800 μl for metagenomic sequencing and 200 μl for real-time fluorescence quantitative PCR verification. The TIANamp Micro DNA Kit was used to extract the sample DNA for metagenomic sequencing, and the ultrasonic fragment was broken to 200-300 bp. The BGISEQ-500 platform was used for sequencing. The data with low quality and length less than 35 bp were cleared from the sequencing data to obtain high-quality data. Through biological authentication software, the reference human genome sequence and low complexity were removed from high-quality data. The data obtained were compared with a special microorganism database regarding the percentage of microbial sequences, the number of unique sequences, coverage and sequencing depth, so as to determine positive sequencing parameters, which were classified into bacteria, viruses, fungi and parasites. Real-time fluorescence quantitative PCR was performed to validate the accuracy. Results: A variety of microorganisms were detected by metagenomic sequencing in 19 specimens, including 3 cases of varicella zoster virus, 2 cases of Candida albicans, 1 case of Propionibacterium acnes and 1 case of Haemophilus parainfluenzae. The percentage of microbial sequences was 77.93% （1 794/2 302）, 99.98% （12 843/12 845） and 98.88%（5 733/5 798）, and the number of unique sequences was 1 794, 12 843 and 57 33 in varicella zoster virus cases, respectively. The verification of varicella zoster virus by PCR was consistent with that by metagenomic sequencing. Conclusion: Metagenomic sequencing can be used as an alternative method for laboratory diagnosis of infectious uveitis. (Chin J Ophthalmol, 2020, 56: 519-523).

Varicella Zoster Virus Causing Aseptic Meningitis Without Fever or Rash in an Immunocompetent Patient

Varicella-Zoster Virus (VZV) is known to be a cause of aseptic meningitis and can be potentially fatal. VZV meningitis can arise in immunodeficient and more rarely, immunocompetent hosts. We present here a rare case of VZV causing meningitis in a 44-year-old immunocompetent man. He presented with an isolated headache without any fever or rash. CSF PCR for VZV DNA was positive confirming VZV as the cause of meningitis. He was treated with IV ganciclovir for 3 days and was transitioned to oral valacyclovir to complete a total of 10 days of antiviral treatment with the resolution of the headache. The purpose of this case report is to highlight VZV as a cause of aseptic meningitis in immunocompetent individuals and emphasize the importance of using airborne precautions along with contact precautions in health care workers who deal with patients with VZV shingles.

1821. Evaluation of Cerebrospinal Fluid White Blood Cell Count Criteria for Use of the BioFire® FilmArray® Meningitis/Encephalitis Panel in Immunocompetent Patients

BackgroundIn 2016, our academic medical center implemented the BioFire® FilmArray® Meningitis/Encephalitis Panel (MEP), which detects 14 viral, bacterial, and fungal pathogens. Institutional guidelines recommended the test be used in nonimmunocompromised patients age ≥2 years only if the cerebrospinal fluid (CSF) white blood cell (WBC) count was >10 cells/mm3.MethodsWe reviewed all MEP performed at our institution over 2 years (January 1, 2017 to December 31, 2018). We collected CSF WBC count, protein, and glucose; MEP results; CSF culture results; and demographics. We excluded children age <2 years, immunocompromised patients, those without a CSF WBC count, and duplicate tests during the same illness.ResultsOf 453 patients, 311 met inclusion criteria. The median age was 51, 51% male. Median CSF indices: WBC/mm3 = 4, protein = 57 mg/dL, glucose = 66 mg/dL. MEP positivity rate = 12% (37/311): viruses (29/37), bacteria (7/37), and fungi (1/37). Positive bacterial/fungal MEP results compared with CSF culture are summarized in Table 1. No clinically significant discordant negative MEP results occurred compared with CSF culture, cryptococcal antigen, or other viral PCR testing. Of the 311 patients, 184 (59%) had ≤10 CSF WBC/mm3. Of these, 4 had positive MEP results: 1 enterovirus, 1 human herpes virus 6 (HHV-6) and 2 varicella zoster virus (VZV). The HHV-6 was judged clinically insignificant. The 2 VZV cases had concomitant shingles and were already on acyclovir. No clinically significant MEP results occurred in 110/311 (35%) patients with ≤ 2 CSF WBC/mm3.ConclusionIn nonimmunocompromised patients, age ≥ 2, with ≤ 10 CSF WBC/mm3 on lumbar puncture, positive MEP results were rare and the clinical significance of the 4 positives was debatable. A hard-stop restriction in this setting could have reduced overall use by up to 59% and resulted in significant cost savings. Lower CSF WBC/mm3 cut-offs could be considered and still improve MEP utilization. Disclosures All Authors: No reported Disclosures.

Varicella zoster virus infection presenting with unilateral panuveitis

In this case report, we present a unique case of varicella zoster virus (VZV) infection that presented with unilateral panuveitis. The patient came with complaints of burning sensation of his left eye, and on examination, the presence of viral pocks over the face and trunk, anterior chamber cells and flare, and iritis were noted along with vitritis and retinitis and he was diagnosed as left eye VZV-associated panuveitis. VZV infection can present with panuveitis in rare occasions, and this is the first of its kind to be reported in India.

Human Herpesvirus Alpha Subfamily (Herpes Simplex and Varicella Zoster) Viral Pneumonias: CT Findings.

The aim of this study was to evaluate CT features of pneumonias caused by the alpha Herpesviruses, herpes simplex virus (HSV), and varicella-zoster virus (VZV). By searching the electronic medical record from 2005 to 2017, we identified 12 patients with HSV and 15 with VZV pneumonia. Four patients with coinfection were excluded from imaging analysis. Two radiologists reviewed computed tomography scans (CTs) for findings including ground glass and nodules. CTs were assigned to a predominant pattern of crazy paving, nodular, or other. The most common risk factor was hematologic malignancy, present in 58% of HSV and 47% of VZV patients. Crazy paving was seen in 50% of HSV and 31% of VZV cases; a nodular pattern was present in 20% of HSV and 69% of VZV patients (P=0.03). Most patients with alpha Herpesvirus pneumonias demonstrated either a crazy paving or nodular pattern on CT. The nodular pattern was significantly more common in VZV than in HSV. Radiologists should consider these rare infections when evaluating immunocompromised patients with these imaging patterns.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Unusual Manifestation of Herpes Zoster Infection Involving the Greater, Lesser Occipital and Transverse Cervical Nerve: A Case Report

We here present a case of Varicella Zoster Virus (VZV) infection with involvement of C2 and C3 right cranial nerve. The initial symptoms (right occipital neuralgia, pharyngodynia, and otalgia) were complicated by vesicular skin lesions spread along the course of the right transverse cervical and of greater occipital nerve. The diagnosis was confirmed by serological tests. Therapeutical approach is then commented.

A prospective study of the clinical characteristics of patients with herpes simplex and varicella zoster keratitis, presenting to a New Zealand emergency eye clinic.

To identify the demographic and clinical associations of patients presenting with herpetic keratitis in New Zealand compared with presentations of presumed microbial keratitis. A prospective, 6-month, observational case series of presumed microbial keratitis (including marginal keratitis), specifically identifying all cases of herpes simplex and varicella zoster keratitis attending an emergency eye clinic was conducted. Main outcome measures included demographics, presenting signs and symptoms, and medical, ocular, and drug history. A total of 140 cases of herpetic keratitis were identified, which comprised 125 cases of herpes simplex virus (89%) and 15 cases of varicella zoster virus (11%). Herpes simplex keratitis was associated with a history of keratitis (n = 58, phi = 0.24, P < 0.0001), Maori ethnicity (n = 27, phi = 0.26, P < 0.0001), respiratory disease (n = 18, phi = 0.14, P = 0.009), corticosteroid use (n = 23, phi = 0.22, P < 0.0001), and cardiovascular disease (CVD) (n = 10, phi = 0.11, P = 0.03). Inverse association was observed between herpes simplex keratitis and ocular surface disease (n = 8, phi = -0.16, P < 0.002) and Asian ethnicity (n = 4, phi = -0.11, P = 0.04). Varicella zoster keratitis was associated with CVD (n = 3, phi = 0.15, P = 0.03). Patients with asthma, CVD, on long-term corticosteroid inhalers or creams, or of Maori ethnicity need particular assessment to investigate herpes simplex as a possible cause of keratitis. Clinicians prescribing inhaled corticosteroids or topical corticosteroid creams should be aware of possible association with herpes simplex keratitis.

CR0299 Herpes zoster virus–associated erythema multiforme in a child

Erythema multiforme (EM) is a mucocutaneous condition, rarely associated with varicella zoster virus (VZV) infection in children, despite the virus's high incidence as a childhood pathogen. In the literature, only 2 cases of VZV associated with EM have been recorded, one in a 5-year-old and the other in a 13-year-old. One case of VZV associated with Stevens-Johnson syndrome in a 12-month-old has also been reported to date.

Cerebral microbleeding in varicella-zoster viral meningitis: An early sign of vasculopathy?

A 75-year-old man undergoing chemotherapy for prostate cancer for 3 months presented with headache after having blisters in his left ear canal and auricle. His body temperature at presentation was 38°C. Neurologic examination revealed nuchal stiffness and left peripheral facial palsy. We also noted leukocytopenia (2,000/µL) and elevated serum C-reactive protein (8.51 mg/dL). CSF analysis showed no erythrocytes, elevated leukocytes (640/µL; 3% monocytes, 97% neutrophils), an increased protein level (473 mg/dL), and slightly decreased glucose level (51 mg/dL, serum glucose 120 mg/dL). Brain MRI and magnetic resonance angiography (MRA) on the day of admission were normal except for irregular gadolinium (Gd) enhancement of the cerebral sulci and basal meninges consistent with meningitis (figure, A–E). Upon noting Ramsay Hunt syndrome from the patient's clinical history and considering the known predominance of neutrophils in CSF in early cases of varicella-zoster virus (VZV) infection of the nervous system,1 we initiated treatment with IV acyclovir (ACV; 1,800 mg/day) for suspicion of VZV meningitis. The patient's symptoms then gradually improved. Existence of VZV within CSF was later confirmed by PCR testing and high anti-VZV immunoglobulin M (IgM) antibody index (1.68; normal range <0.8) results. Two weeks after ACV treatment initiation, follow-up MRI showed attenuated Gd enhancement of the meninges; unexpectedly, diffusion-weighted imaging (DWI) showed a small acute infarction of the right insula (figure, F), and T2-weighted imaging (T2*WI) showed microbleeding in the left anterior cingulate gyrus (figure, G) and the midbrain interpeduncular fossa (figure, H). MRA revealed no apparent narrowing or malformation of the arteries. Without risk factors for cerebrovascular disease such as arrhythmia, hypertension, or coagulation abnormality, our clinical and radiologic findings taken together with patient history suggested small-vessel vasculopathy associated with VZV infection; therefore, oral dexamethasone (DEX; 1 mg/day) was added to the original treatment. Both ACV and DEX were continued for 2 months until the CSF testing and the anti-VZV IgM antibody index returned to normal. No clinical or radiologic signs of relapse were detected during the therapeutic course.

Immunological Responses to Varicella-Zoster Virus (VZV) in Basrah with Special Emphasis on the Pattern of Exposure

The study aimed on the study of pattern of exposure and immunological responses to varicella-zoster virus (VZV) infection. Methods: A seroepidemiological study was carried out on 92 blood samples collected from children in primary health care centers and outpatient clinics of Al-Sader Teaching and Basrah maternity and children hospital during the period from January 2007 till March 2008. Serological responses were investigated by an enzyme-linked immunosorbent assay (ELISA) to detect VZV IgG antibody and cellular responses was detected by Erythrocyte rosette (E-Rosette) formation test. Results: The overall VZV- antibody prevalence was 53.3% for both serologic and cellular responses. The degree and pattern of exposure to VZV cases plays important role in the seroconversion and responses to VZV infections. The greatest responses observed in those with direct contact (household) with chickenpox cases (68.6% and 74.3%) and the direct contact acquired from VZV infected mothers (80% for both serologic and cellular responses). Exposure to typical chickenpox cases confers higher serologic and cellular responses (75% and 94.4% respectively). Cellular responses to VZV infections lasted longer than that for serologic responses. Sever VZV infections confers significantly higher levels of immunity (100%) and the complication post VZV infections (Pneumonia and encephalitis) mostly associated with sever cases at earlier age groups rather than the mild VZV cases. The differences in immune responses to VZV infections between male and females was significant (P

Varicella zoster virus vasculopathy: A treatable form of rapidly progressive multi-infarct dementia after 2 years' duration

We describe an extraordinarily protracted case of varicella zoster virus (VZV) multifocal vasculopathy in a man who presented initially with ischemic optic neuropathy and then suffered 4 episodes of stroke manifesting as multi-infarct dementia over a 2-year period. Brain magnetic resonance imaging (MRI) and angiography (MRA) revealed cortical and subcortical infarctions as well as vasculitic occlusion and stenosis. The patient was treated with corticosteroids and later with cyclophosphamide. More than 2years after the onset of neurological disease, two cerebrospinal fluid (CSF) examinations revealed the presence of anti-VZV IgG antibody with reduced serum-to-CSF ratios of anti-VZV IgG compared with ratios for total IgG and albumin, indicative of intrathecal synthesis of anti-VZV IgG. After definitive diagnosis, immunosuppressive drugs were discontinued and he was treated with intravenous acyclovir; both mental status and gait improved and no further episodes of neurological dysfunction ensued. The favorable outcome in this patient indicates that VZV vasculopathy can be treated successfully even after 26months. VZV must be considered as a possible cause of neurological disease in any patient with idiopathic multifocal vasculopathy.