Varicella In Adults Research Articles

THE COURSE OF CHICKENPOX IN ADULTS AND CHILDREN

The report shows the clinical and epidemiological data analysis of 100 patients with chickenpox adults and children. The comparative frequency of the main symptoms of chickenpox in adults and children, including newborns. The features of the disease in adults: prevalence of severe (70%) with prodromal symptoms, febrile fever, rash abundant large slow and reverse the development of pruritus. We describe the clinical symptoms of chickenpox in infants, depending on the timing of chickenpox disease pregnant women before delivery. It is noted for heavy chickenpox in the newborn, the possibility of developing their generalized forms with the defeat of visceral organs and the central nervous system, diseases of pregnant 3—4 days before delivery. The data on the treatment and prevention tactics doctor for chickenpox.

Ocular involvement associated with varicella in adults.

BackgroundVaricella is a common infectious disease primarily of childhood that is usually benign and self-limited. It is, however, increasingly seen in adults who are at a higher risk of severe infection. Ocular complications of varicella are relatively uncommon and have been rarely described in adults. We describe herein five adults who developed ocular involvement in association with primary varicella-zoster virus infection.FindingsOcular manifestations included acute anterior uveitis in four eyes, with associated stromal keratitis in one of them, epithelial ulcerative keratitis in the two eyes of one patient, and acute retinal necrosis in one eye. One patient with acute anterior uveitis was treated with topical steroids and cycloplegic agents. The four other patients received topical or systemic antiviral drugs, with subsequent resolution of acute ocular inflammatory disease.ConclusionsThe spectrum of chickenpox-associated ocular complications in adults is wide. Early diagnosis and appropriate management are mandatory to improve visual outcome.

Relationship between Plasma Concentrations of Interleukin-10 and Thrombocytopenia in Chickenpox Patients

Background and study aim: Chickenpox is highly infectious, self-limiting disease, caused by varicella-zoster virus. Thrombocytopenia frequently complicates chickenpox. This study was conducted to assess the correlation between serum interleukin 10 levels and thrombocytopenia in adult chickenpox patients. Patients and Methods: Fifty patients of chickenpox complicated by thrombocytopenia were included in this study as a patient group. Fifty patients of chickenpox with normal platelet of comparable age, race and gender were identified as a control group. All patients were diagnosed by clinical picture of chickenpox and by presence of varicella - zoster virus immunoglobulin M (VZV IgM) in the patient blood. Estimation of complete blood count, kidney function tests, liver function tests, fasting blood sugar, and levels of cytokines IL-10 and TNF-α were done in both groups on the day of admission and day of discharge. Results: At time of admission, IL-10 levels were significantly higher in patients group than in control group, while TNF-α level were not significantly different between the two groups. At time of discharge, we observed a significant decline in IL-10 levels in the patients group as compared with time of admission. A negative correlation between IL-10 levels and platelet count was observed while no correlation was found between TNF-α and platelet count. Conclusion: IL-10 level could play an important role in development of thrombocytopenia in patients with chickenpox.

Vaccines for postexposure prophylaxis against varicella (chickenpox) in children and adults.

For the current issue of the Journal, we asked Dr Jane McDonald to comment on and put into context the Cochrane Review on vaccines for postexposure prophylaxis against varicella in children and adults.

Neurological complications due to chicken pox in adults: A retrospective study of 20 patients.

Neurological complications due to chicken pox in adults: A retrospective study of 20 patients.

Varicella pneumonia in an immunocompetent adult: A case report

The clinical presentation of varicella in adults is frequently associated with complications, particularly varicella pneumonia. Most cases occur in immunocompromised adults but immunocompetent can have serious pulmonary compromise. We report the case of an immunocompetent patient admitted to the intensive care unit with dyspnea and an exanthematous vesicular rash. We diagnosed varicella pneumonia based on the presence of a typical skin rash, pulmonary symptoms and contact with a child with chickenpox, confirmed by positive serology of varicella zoster virus (VZV). The patient made a full recovery with mechanical ventilation and anti-viral therapy.

A site of varicella-zoster virus vulnerability identified by structural studies of neutralizing antibodies bound to the glycoprotein complex gHgL

Varicella-zoster virus (VZV), of the family Alphaherpesvirinae, causes varicella in children and young adults, potentially leading to herpes zoster later in life on reactivation from latency. The conserved herpesvirus glycoprotein gB and the heterodimer gHgL mediate virion envelope fusion with cell membranes during virus entry. Naturally occurring neutralizing antibodies against herpesviruses target these entry proteins. To determine the molecular basis for VZV neutralization, crystal structures of gHgL were determined in complex with fragments of antigen binding (Fabs) from two human monoclonal antibodies, IgG-94 and IgG-RC, isolated from seropositive subjects. These structures reveal that the antibodies target the same site, composed of residues from both gH and gL, distinct from two other neutralizing epitopes identified by negative-stain electron microscopy and mutational analysis. Inhibition of gB/gHgL-mediated membrane fusion and structural comparisons with herpesvirus homologs suggest that the IgG-RC/94 epitope is in proximity to the site on VZV gHgL that activates gB. Immunization studies proved that the anti-gHgL IgG-RC/94 epitope is a critical target for antibodies that neutralize VZV. Thus, the gHgL/Fab structures delineate a site of herpesvirus vulnerability targeted by natural immunity.

Vaccination against varicella as post-exposure prophylaxis in adults: A quantitative assessment

BackgroundVaricella can be severe in adults. When universal vaccination is not adopted, post-exposure prophylaxis has been recommended in adults with uncertain history of varicella to reduce the burden of the disease in adults, however its impact is not quantified. MethodsWe developed a Bayesian probabilistic framework to estimate the impact of post-exposure prophylaxis in adults. We hypothesized that post-exposure vaccination would be proposed only after varicella exposure in close relatives. Information regarding the nature of the culprit exposure was obtained from a sample of 221 adult varicella cases. The lifelong probability that adults aged 18 would be infected with varicella was determined using data from the French Sentinelles surveillance network. Estimates of post-exposure vaccination efficacy were then used to compute the number of cases and hospitalizations prevented in adults. ResultsFamilial exposure to varicella was reported by 81 adult cases out of 221. The probability of infection after exposure was 32%, so that six exposures on average were necessary to explain the observed cumulated lifetime incidence of varicella in non-immune 18 years old and over adults. Among the 35% of the 18 years old population with uncertain history of varicella, 11% would truly be non-immune. Post-exposure vaccination would prevent 26% of the cases (13 cases prevented per 100,000 adults per year) and 31% of the hospitalizations (0.2 hospitalizations prevented per 100,000 adults per year) if vaccination acceptance was 70%. An average of 16 adults would be vaccinated to avert one varicella case. ConclusionsPost-exposure vaccination is associated with a substantial decrease in the burden of the disease in adults in a country where universal vaccination is not recommended. This quantitative information may help inform professionals to uphold the recommendation.

Torrential Abdominal Wall Bleeding After Percutaneous Endoscopic Gastrostomy Tube Placement

Introduction: Percutaneous endoscopic gastrostomy (PEG) procedure is one of the most commonly performed gastrointestinal procedure in United States. Hemorrhage can occur rarely, and most of the time can be controlled by local compression without any surgical interventions. Here we have reported a case of superior epigastric artery injury during gastrostomy tube placement, which required immediate surgical intervention. A 60-year-old female was admitted to hospital and managed for non-STEMI, septic shock from Clostridium difficille colitis and adult onset chicken pox. After recovery from the septic shock, she remained cognitively impaired and gastrostomy tube was placed endoscopically for poor oral intake to ensure long-term enteral feeding. She was not on antiplatelets or anticoagulants. Immediately after procedure, she was noticed to have profuse bleeding from the incision, which could not be controlled by local compression and suturing by endoscopist. Emergency surgical consultation and urgent exploration of the wound revealed active bleeding from superior epigastric artery, which was ligated surgically. The patient’s recovery was uneventful, and she was discharged to long-term care facility. Severe hemorrhage requiring surgical intervention is an uncommon complication of percutaneous endoscopic gastrostomy. Immediate surgical intervention might be needed if bleeding could not be controlled by pressure, and suturing at the PEG incision site. Superior epigastric artery damage may be avoided by a more lateral or midline incision.

A seroprevalence survey on varicella among adults in the vaccination era in Apulia (Italy)

In 2006, the Apulia Region (Italy) introduced universal routine vaccination (URV) against varicella disease. The coverage for one dose of varicella vaccine at 24 month of age reached 91.1% in 2010 birth-cohort. Vaccination coverage for the second dose at 5–6 years was 64.8% for the cohort 2005, and 28.8% for adolescents born in 1997. The aim of the present study is to evaluate the pattern of immunity/susceptibility to varicella in Apulian adults by a seroprevalence survey carried out 6 years after the introduction of URV.The study was carried out from May 2011 to June 2012 among blood donors of the Department of Transfusion Medicine of Policlinico General Hospital in Bari. Subjects were enrolled by a convenience sample. For each enrolled patient we collected a sample of serum of 5ml. Anti-VZV IgG in collected sera were analyzed by chemiluminescence (CLIA).We enrolled 1769 subject; 1365 (77.2%) were male with a mean age of 38.4±11.7 years. 93% (95% CI=91.7–94.1) of enrolled subject presented a titre of anti-VZV IgG >164mIU/mL. GMT of anti-VZV IgG titre was 1063.4mIU/ml and no difference was observed between different age group.According to our data, URV did not seem to have any impact on susceptibility among adults and in particular we did not note any cluster of susceptible subjects among young adults. Also in the vaccination era, we did not note that the average age of infection shifts among adults and then we could exclude an increase of case of complicated varicella related to the URV.

Varicella pneumonia associated with spontaneous popliteal arterial thrombosis in an adult: a case study and review of the literature

Introduction: Chickenpox is generally a childhood exanthematic benign self‐limited disease. In contrast, most complications and fatal cases occur among adults, which is the group that suffers less commonly from this disease. The frequency of chickenpox in adults is increasing worldwide, together with the associated complications, mainly varicella pneumonia, which can lead to death. The incidence of other complications such as peripheral artery thrombosis is much lower but can cause important morbidity. Case presentation: We report the case of a 63‐year‐old male smoker, who was otherwise previously healthy, who was admitted to the Emergency Department with chickenpox and varicella pneumonia with respiratory insufficiency requiring mechanical ventilation and intensive care unit admission. During hospitalization, the patient developed spontaneous popliteal artery thrombosis that finally led to transfemoral amputation. Conclusions: Varicella pneumonia and peripheral artery thrombosis are two of the known complications of chickenpox. Both complications seem to be much more frequent in men with an active smoking habit. Clinicians should be aware of these complications in order to recognize them promptly and provide adequate treatment.

One-dose vaccination associated with attenuated disease severity of adolescent and adult varicella cases in Beijing’s Fengtai District

Background In recent years, the number of varicella cases in adults has significantly increased in Beijing. However, the effect of the vaccination on varicella-related characteristics among adults has not been studied.Methods and Results: Using data from the Infectious Disease Reporting System and the Immunization Information System, we compared the epidemiology and disease severity in breakthrough and unvaccinated varicella cases in adolescents and adults (≥ 15 year-old) from 2008 to 2011 in Beijing’s Fengtai district, China. The results showed that the age (P = 0.003),contact history (90% vs. 73%, P = 0.019) and outbreak cases (10% vs. 1%, P < 0.0001) were significantly differently distributed between the two groups and that both the incidence of moderate-to-severe cases (26% vs. 45%, P = 0.035, OR = 0.446) and varicella-associated fever (49% vs. 66%, P = 0.068, OR = 0.534) were either significantly lower or trended to be lower in the breakthrough group than in the unvaccinated group. Additionally,vaccine effectiveness against moderate-to-severe cases of varicella was 55.4%.Conclusion: Altogether, these results indicate that vaccination against varicella among adolescents and adults affected the epidemiology and attenuated the disease severity of the cases. The Results from this study will provide useful information for the prevention of varicella in adolescents and adults.

Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults.

The prevention of varicella (chickenpox) using live attenuated varicella vaccines has been demonstrated both in randomised controlled trials (RCTs) and in population-based immunisation programmes in countries such as the United States and Australia. Many countries do not routinely immunise children against varicella and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. The use of varicella vaccine in persons who have recently been exposed to the varicella zoster virus has been studied as a form of post-exposure prophylaxis (PEP). To assess the efficacy and safety of vaccines for use as PEP for the prevention of varicella in children and adults. We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to March week 1, 2014), EMBASE (January 1990 to March 2014) and LILACS (1982 to March 2014). We searched for unpublished trials registered on the clinicaltrials.gov and WHO ICTRP websites. RCTs and quasi-RCTs of varicella vaccine for PEP compared with placebo or no intervention. The outcome measures were efficacy in prevention of clinical cases and/or laboratory-confirmed clinical cases and adverse events following vaccination. Two review authors independently extracted and analysed data using Review Manager software. We identified three trials involving 110 healthy children who were siblings of household contacts. The included trials varied in study quality, vaccine used, length of follow-up and outcomes measured and, as such, were not suitable for meta-analysis. We identified high or unclear risk of bias in two of the three included studies. Overall, 13 out of 56 vaccine recipients (23%) developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients (78%). Of the vaccine recipients who developed varicella, the majority only had mild disease (with fewer than 50 skin lesions). In the three trials, most participants received PEP within three days following exposure; too few participants were vaccinated four to five days post-exposure to ascertain the efficacy of vaccine given more than three days after exposure. No included trial reported on adverse events following immunisation. These small trials suggest varicella vaccine administered within three days to children following household contact with a varicella case reduces infection rates and severity of cases. We identified no RCTs for adolescents or adults. Safety was not adequately addressed.

Adult Primary Varicella Pneumonia: High-resolution Computed Tomography Findings

Adult Primary Varicella Pneumonia: High-resolution Computed Tomography Findings

Deep Sequencing of Viral Genomes Provides Insight into the Evolution and Pathogenesis of Varicella Zoster Virus and Its Vaccine in Humans

Immunization with the vOka vaccine prevents varicella (chickenpox) in children and susceptible adults. The vOka vaccine strain comprises a mixture of genotypes and, despite attenuation, causes rashes in small numbers of recipients. Like wild-type virus, the vaccine establishes latency in neuronal tissue and can later reactivate to cause Herpes zoster (shingles). Using hybridization-based methodologies, we have purified and sequenced vOka directly from skin lesions. We show that alleles present in the vaccine can be recovered from the lesions and demonstrate the presence of a severe bottleneck between inoculation and lesion formation. Genotypes in any one lesion appear to be descended from one to three vaccine-genotypes with a low frequency of novel mutations. No single vOka haplotype and no novel mutations are consistently present in rashes, indicating that neither new mutations nor recombination with wild type are critical to the evolution of vOka rashes. Instead, alleles arising from attenuation (i.e., not derived from free-living virus) are present at lower frequencies in rash genotypes. We identify 11 loci at which the ancestral allele is selected for in vOka rash formation and show genotypes in rashes that have reactivated from latency cannot be distinguished from rashes occurring immediately after inoculation. We conclude that the vOka vaccine, although heterogeneous, has not evolved to form rashes through positive selection in the mode of a quasispecies, but rather alleles that were essentially neutral during the vaccine production have been selected against in the human subjects, allowing us to identify key loci for rash formation.

Chickenpox and Risk of Stroke: A Self-controlled Case Series Analysis

There is good evidence that respiratory and other infections that cause systemic inflammation can trigger strokes; however, the role of specific infections is unclear. Case reports have highlighted chickenpox as a possible risk factor for arterial ischemic stroke, particularly in children, but rigorous studies are needed to determine and quantify any increased risk. We used anonymized electronic health records totaling >100 million person-years of observation from 4 UK primary care databases to identify individuals who had documented clinical chickenpox and a stroke or transient ischemic attack (TIA). Self-controlled case series methods were used to quantify any increased risk of first stroke or TIA in the 0-6 and 7-12 months following chickenpox compared to other observed time periods. We analyzed data within each database, and performed meta-analyses to obtain summary age-adjusted incidence ratios (IRs) separately for adults and children. Five hundred sixty eligible individuals (including 60 children) were identified who experienced chickenpox and a stroke or TIA during follow-up. Among children, there was a 4-fold increased risk of stroke in the 0-6 months after chickenpox (summary IR = 4.07; 95% confidence interval [CI], 1.96-8.45; I(2) = 0%). Among adults, there was a less marked increased risk with moderate between-database heterogeneity (random-effects summary IR = 2.13; 95% CI, 1.05-4.36; I(2) = 51%). There was no significant increased risk of stroke in the 7-12 months after chickenpox in children or adults, nor was there evidence of increased risk of TIA in either time period. Our study provides new evidence that children who experience chickenpox are at increased risk of stroke in the subsequent 6 months.

Efficacy analysis of acyclovir combined with pidotimod in treatment of adult varicella

Objective To explore the curative effect of acyclovir combined with pidotimod in treatment of adult varicella.Methods 80 adult patients with varicella in our hospital were randomly divided into two groups.40 cases in group A were intravenously injected acyclovir.40 cases in group B were intravenously injected acyclovir combined with oral pidotimod.The time of herpes blisters drying and completely crusted were observed in two groups.Results The time of herpes blisters drying and completely crusted of B group was shorter than A group.And the differences were statistically significant(P ＜0.01).Conclusion Acyclovir combined with pidotimod in treatment of adult varicella can significantly shorten the healing time,and show better curative effect than single use of acyclovir. Key words: Adult varicella; Efficacy; Pidotimod; Acyclovir

Bronchial ulceration as a prognostic indicator for varicella pneumonia: Case report and systematic literature review

Adult varicella pneumonia is a common and serious complication of varicella zoster virus (VZV) infection in pregnant woman and immunocompromised individuals, with mortality rates of 30–50%. The poor prognosis is attributable to very aggressive disease progression and delayed onset of treatment. Here, we present a case of varicella pneumonia in a 69-year-old woman following long-term immunosuppressive treatment for kidney transplant. Respiratory failure developed within 3d after admission for skin rash, and the patient died 28d later despite acyclovir and foscarnet treatment. The autopsy showed extensive mucosal airway ulcerations from the pharynx to the main bronchi and numerous VZV-infected cells. We searched PubMed, Web of Science, and EMBASE (1980 through February 2012), as well as several medical report databases created by Japanese healthcare professionals, for all reported cases of varicella pneumonia for which bronchoscopy findings were documented. Twenty-four cases were included and we found that patients with limited or shallow ulcers had favorable outcomes, whereas patients with vast and deep ulcerations had fatal outcomes. These findings indicate that bronchoscopy findings, particularly those showing bronchial involvement, may be useful for evaluating varicella pneumonia.

The epidemiological analysis of varicella in the Third Affiliated Hospital of Guangzhou Medical College from 2005 to 2011

Objective To study the epidemiological characteristics of varicella in the Third Affiliated Hospital of Guangzhou Medical College from 2005 to 2011.Method The data of varicella patients from Jan 2005 to Dec 2011 was analyzed.Results There were 823 cases in all.Most of the patients were 2 ～ 10 years old,but the onset age had been increasing year by year.The proportion of adult varicella patients was increasing yearly from 2005 to 2011.Most of the patients occurred in December and January.Conclusion We should pay attention to the prevention and control of varicella. Key words: Varicella; Epidemiology

Dexamethasone as adjunctive therapy for treatment of varicella pneumonia

BackgroundThe most common and most serious complication of varicella (chickenpox) in adults is pneumonia, which can lead to severe respiratory failure. Whether addition of corticosteroids to antiviral treatment benefits patients with varicella pneumonia is unclear. ObjectivesTo assess the effect of dexamethasone as adjunctive therapy for treatment of varicella pneumonia on the length of hospital stay, which might cause earlier resolution of varicella pneumonia. Patients and methodsForty patients were diagnosed as varicella pneumonia and divided into two groups, the first one involved 20 patients who received dexamethasone and acyclovir, and the second one involved also 20 patients but they received placebo and acyclovir. We measured liver function test, kidney profile, complete blood count, blood glucose, C-reactive protein and the levels of interleukin-6 on the day of presentation, after 4days of admission and on the day of discharge from the hospital. ResultThe mean length of hospital stay in the dexamethasone group was 6.5days compared with 7.1days in the placebo group and was significantly different between two groups. The mean time of switching to oral administration of acyclovir was 3.4days in the dexamethasone group and 4.2days in the placebo group. The mean time of switching to oral was significantly lower in dexamethasone group than in placebo group. ConclusionAdding of dexamethasone to acyclovir in patients with varicella pneumonia can reduce the length of hospital stay.