Complication Of Varicella Zoster Virus Infection Research Articles

Ramsay Hunt Syndrome: A Rare Disease of Multiple Cranial Nerve Involvement

Ramsay Hunt Syndrome (RHS) also known as herpes zoster oticus is a viral disease, a member of the human herpes virus family, is a late complication of varicella-zoster virus infection that results in inflammation of the geniculate ganglion of cranial nerve VII. Ramsay Hunt is a clinical diagnosis. The hallmark of the condition is multiple unilateral erythematous vesicles, which are distributed over the auricle and preceded by severe otalgia. If these symptoms are associated with facial nerve palsy, the condition is called RHS which is usually accompanied by vestibulocochlear abnormalities. Diagnosis is often missed or delayed, which can lead to an increased incidence of long-term complications. The condition is self-limiting, but treatment is targeted at decreasing the total duration of the illness as well as providing analgesia and preventing the complications that can occur. This activity reviews the role of the inter professional team in the diagnosis and treatment of RHS. Mugda Med Coll J. 2024; 7(1): 48-52

Disseminated herpes zoster with mucosal involvement in an immunosuppressed child.

To the editor: We report the case of a 14-year-old boy who presented with some painful, confluent, and erythematous vesicles on the left lumbosacral side, with a 2-day history of fever, severe headache, and fatigue (Figure 1A). There were no convulsions, abdominal pain, or diarrhea. Over the next 5 days, the skin lesions progressed to scattered vesicles throughout the face, trunk, extremities, and oral mucosa (Figure 1B). The boy had a medical history of juvenile rheumatoid arthritis for 7 years and was taking prednisone and thalidomide. He had experienced chicken pox before. The level of C-reactive protein was 71 mg/L (normal range, <8 mg/L), and the immunoglobulin M antibody against varicella zoster virus (VZV) was positive. A biopsy of the lumbosacral lesion revealed the vesicle ballooning degeneration of intraepidermal keratinocyte, and wedge necrosis of the epidermis and dermis (Figure 1C). Localized lymphocytes and sporadic neutrophils, histiocytes, and plasma cells infiltrated the perivascular area in the superficial dermis. The final diagnosis was disseminated herpes zoster (HZ). The patient was treated with intravenous acyclovir for 2 weeks. The vesicles dried up after 7 days, and the skin lesions were resolved after 2 weeks. Disseminated HZ is a serious complication of VZV infection, which may be related to increased risk and potentially fatal complications.1 This almost always happens in immunocompromised people who present with more than 20 vesicles outside the area of primary or adjacent dermatomes, and where mucous membranes are involved. Disseminated HZ may also occur during medication, including with biological agents and small molecule drugs.2, 3 This patient was immunocompromised owing to the long-term use of prednisone. To summarize the mucosal involvement of HZ, a literature review was performed at PubMed from inception to April 15, 2022. The search strategy included “herpes zoster” AND (“mucosa” OR “mucous membrane”) AND “case”; only English-language studies were included. Thirty-one references with 34 cases were ultimately included. The results of mucosal involvement and complications are listed in Table S1. The reported mucosal involvement included oral, tongue, gingiva, pharyngeal, larynx, esophagus, gastric area, intestine, and ears. Oral mucosal involvement was common in patients with Ramsay Hunt syndrome (RHS).4 Most reported cases with mucosal involvement were adults. Most patients recovered after antiviral treatment but several patients died because of complications and organ failure. Systemic treatment with acyclovir and famciclovir can reduce the duration of skin lesions.5 In this case, the patient was a child without RHS and the lesions were resolved after acyclovir treatment without any complications with post-herpetic neuralgia. In summary, disseminated HZ, as a severe form of HZ, should not be ignored. Both the skin and mucosa can be involved, and early diagnosis and antiviral treatment are important to shorten the duration of the disease and improve the prognosis. This work was supported by Beijing Natural Science Foundation (No. 7222058). Informed consent was obtained from the patient's parent. The authors declare that they have no conflicts of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The incidence of neurological complications of varicella-zoster virus infection in hospitalised children in a population with low vaccination coverage

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Frąszczak J, Mania A, Kemnitz P, Mazur-Melewska K, Figlerowicz M. The incidence of neurological complications of varicella-zoster virus infection in hospitalised children in a population with low vaccination coverage. Pediatria Polska - Polish Journal of Paediatrics. 2022;97(2):95-102. doi:10.5114/polp.2022.115183. APA Frąszczak, J., Mania, A., Kemnitz, P., Mazur-Melewska, K., & Figlerowicz, M. (2022). The incidence of neurological complications of varicella-zoster virus infection in hospitalised children in a population with low vaccination coverage. Pediatria Polska - Polish Journal of Paediatrics, 97(2), 95-102. https://doi.org/10.5114/polp.2022.115183 Chicago Frąszczak, Justyna, Anna Mania, Paweł Kemnitz, Katarzyna Mazur-Melewska, and Magdalena Figlerowicz. 2022. "The incidence of neurological complications of varicella-zoster virus infection in hospitalised children in a population with low vaccination coverage". Pediatria Polska - Polish Journal of Paediatrics 97 (2): 95-102. doi:10.5114/polp.2022.115183. Harvard Frąszczak, J., Mania, A., Kemnitz, P., Mazur-Melewska, K., and Figlerowicz, M. (2022). The incidence of neurological complications of varicella-zoster virus infection in hospitalised children in a population with low vaccination coverage. Pediatria Polska - Polish Journal of Paediatrics, 97(2), pp.95-102. https://doi.org/10.5114/polp.2022.115183 MLA Frąszczak, Justyna et al. "The incidence of neurological complications of varicella-zoster virus infection in hospitalised children in a population with low vaccination coverage." Pediatria Polska - Polish Journal of Paediatrics, vol. 97, no. 2, 2022, pp. 95-102. doi:10.5114/polp.2022.115183. Vancouver Frąszczak J, Mania A, Kemnitz P, Mazur-Melewska K, Figlerowicz M. The incidence of neurological complications of varicella-zoster virus infection in hospitalised children in a population with low vaccination coverage. Pediatria Polska - Polish Journal of Paediatrics. 2022;97(2):95-102. doi:10.5114/polp.2022.115183.

Neurological complications of varicella-zoster virus infection in children

Varicella-zoster virus is an exclusively human α-herpesvirus, known as the aetiological factor of chickenpox which is usually linked with childhood. The disease occurs with a worldwide geographic distribution, and in temperate climates shows a seasonal pattern with epidemics occurring mostly during late winter and spring. The annual incidence is estimated at 80–90 million cases worldwide. Children usually acquire varicella during the first five to 10 years of life, and the highest risk of infection is related to household contacts without a history of vaccination. Although the disease is commonly considered benign, varicella-zoster virus bears the potential of causing a wide range of complications, including the most serious ones of central nervous system manifestations. The neuropathogenesis of varicella-zoster virus infections is not well understood. Based on a wide spectrum of clinical syndromes, multiple theories explaining the pathways of spread of the virus, and host immune response to the viral presence have been proposed, including direct retrograde trafficking of the virus and haematogenous spread as well as inflammatory response with vasculitis. Neurological complications related to varicella-zoster virus infection are the second most common indication for hospitalisation in immunocompetent children with varicella, following skin superinfections. In this paper, the neurological aspects of chickenpox in children are discussed. The characteristics of the clinical syndromes, pathogenesis, methods of diagnosis and treatment, as well as long-term consequences are presented.

Varicella-zoster virus post-exposure management and prophylaxis: A review.

Varicella-zoster virus causes both varicella (chickenpox) and herpes zoster (shingles). Although varicella incidence has dramatically declined since introduction of the live-attenuated varicella vaccine, vaccination rates are suboptimal, and outbreaks still occur. Additionally, herpes zoster incidence continues to rise. Severe or fatal complications may result from varicella transmission to at-risk individuals who are exposed to either varicella or herpes zoster. An increasing number of children and adults are receiving immunosuppressive therapies and are at high risk for severe varicella and other complications if exposed to the virus. Clinical management of individuals exposed to varicella-zoster virus should take into consideration the type of exposure, evidence of immunity, and host-immune status with regard to ability to receive varicella vaccination safely. Post-exposure varicella vaccination may prevent infection or mitigate disease severity in persons eligible for vaccination. Post-exposure prophylaxis with varicella zoster immune globulin is indicated for populations ineligible for vaccination, including immunocompromised children and adults, pregnant women, newborns of mothers with varicella shortly before or after delivery, and premature infants. Appropriate post-exposure management of individuals exposed to either varicella or herpes zoster-including assessment of immune status and rapid provision of optimal prophylaxis-can help avoid potentially devastating complications of varicella-zoster virus infection.

Study of Complications of Varicella-Zoster Virus Infection in Hospitalized Children at a Reference Hospital for Infectious Disease Treatment.

Varicella is a disease with potentially severe complications. We aimed to investigate characteristics of hospitalized children with varicella in Brazil in the prevaccine period and to identify predictors for requiring intensive care treatment. A prospective cohort study was conducted from May 2011 to April 2014. Patients up to 13 years of age with varicella diagnosis were included. Information was collected through interview and review of medical records. Logistic regression analysis was performed. A total of 669 patients were admitted. The median age of subjects was 2.7 years (range 0-14 years) with a predominance of boys (56.6%). The main causes of hospitalization were bacterial complications (77.7%), viral complications (11.4%), and at-risk patients (10.9%). Main bacterial complications were skin infection and pneumonia. Main viral complications were herpes zoster, cerebellitis, and encephalitis. Most at-risk patients used corticosteroids or had a diagnosis of leukemia. At-risk patients were hospitalized earlier (P < .01) and remained hospitalized for longer periods (P = .03). A total of 44 patients (6.6%) were admitted to the ICU, and 5 (0.8%) died of septic shock. Thrombocytopenia was associated with more severe illness in patients with bacterial infections (P = .001). The long-time interval between onset of infection and admission was associated with the need for intensive care in all groups (P = .007). Secondary bacterial infection is the main cause of hospitalization, and thrombocytopenia in these patients leads to worse outcomes. Difficulties of access to the health system and delay in medical care are determining factors of greater severity in this population.

Nervous system complications of varicella-zoster virus infections: A tertiary center experience

Objective: Our aim was to describe the spectrum of central nervous system complications of varicella-zoster virus (VZV) infection in a cohort of children admitted to a tertiary pediatric hospital. Methods: Children younger than 18 years-of-age admitted with neurological signs associated with characteristic rash or a positive serum IgM test were included in the study (n = 28). Study population included stroke patients within 6 months of VZV infection without any other identified etiology. Results: We assessed 28 children with neurological complications due to VZV infection. Median age at presentation was 61 (8-206) months. Median admission period was 7 (1-27) days. Median period of rash before admission and neurological signs were 7 (0-45) days, and 5 (0-43) days respectively. Nausea and vomiting were the initial symptoms for 15/28 patients (%53.5), and the number of vomits ranged between 0-20 (median=1). None of our patients had a previous neurological diagnosis, and had normal development except for 2 patients. At admission 15/28 children had cerebellar signs and 5/28 had encephalopathy. Twenty children had neuroimaging studies (14 had MRI, 5 had CT, one had both). Only 6 of the imaging tests showed abnormal signs, one being an infarct of right middle cerebral artery. Treatment strategies involved no medication (n= 6), only acyclovir (n= 13), only antibiotics (n= 1), and both acyclovir and antibiotics (n= 8). At the time of discharge nearly all patients showed an improvement with 18/28 being totally recovered. Conclusion: Neurological manifestations are a rare but a major concern for VZV infections. In our study most common neurological manifestation was cerebellar ataxia. We would like to note that nausea and vomiting may precede neurological symptoms as in the case of %53.5 of our cohort.

Estudo Clínico-Epidemiológico da Infeção Complicada por Vírus Varicela-Zoster na Idade Pediátrica

In Portugal, the incidence of complicated infection by varicella-zoster virus is unknown. The purpose of this study was to describe the epidemiological and clinical features of complicated infection by varicella-zoster virus in children. Retrospective review of the clinical files of patients admitted between January 1999 and July 2013, with a diagnosis of complicated varicella-zoster virus infection. Ninety-four patients were hospitalized with complicated varicella-zoster virus infection, two of them by reactivation of latent infection. The median age was 38 (IQR 18 - 65) months. The most frequent types of complications were bacterial overinfection of the skin and subcutaneous cellular tissue (37.2%) and respiratory complications (24.5%). Other complications were neurologic complications (19.1%), gastrointestinal (9.6%), hematologic (5.3%) and osteoarticular (4.3%). In 38 patients invasive bacterial infections were diagnosed, with bacteremia in 6 patients. The median age was highest in the immunological complications compared with infectious complications. Neurological complications occurred mainly in healthy children, while infectious complications, including the invasive bacterial infections were more frequent in patients treated with ibuprofen and/or corticosteroids. The evolution was favorable in most cases. The complications of varicella-zoster virus infection occurred mainly in pre-school age and in healthy children. Infectious complications, particularly respiratory complications and bacterial overinfection of the skin and subcutaneous cellular tissue, were the most frequent. There was association between infectious complications and previous therapy with ibuprofen and / or corticosteroids. Multicenter studies should be planned in order to optimize and adjust the vaccine strategies to our reality.

Neurologic complications of varicella-zoster virus infection still occur

Investigators from the Hospital for Sick Children in Toronto collected a series of 84 children 1-18 years of age with central nervous system (CNS) complications associated with varicella-zoster virus (VZV) infection between 1999 and 2012. Cases occurred after recommendation by Canada's National Advisory Committee on Immunization for use of VZV vaccine in children 1 year of age and older in 1999, and public funding for universal vaccination in 2004. Only four of 84 patients had a history of VZV immunization. The series serves as an excellent modern compendium of the variety of neurologic syndromes occurring around the time of VZV rash onset (median 5 days, range 6 days before onset to 42 days after onset, and occasionally in absence of rash): cerebellar ataxia, encephalitis, isolated seizures, meningitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, and Ramsay Hunt syndrome. Additionally, an under-appreciated complication, stroke, occurred in 10 patients at a median 16 weeks (range 2-26 weeks) after rash onset; typical neuroimaging findings were focal ischemia or infarction, with angiographic evidence of characteristic vasculopathy (ie, narrowing or beading in cerebral arteries). Three important reminders from this study, which hopefully would be the last series possible in the era of widespread availability of VZV vaccine, are: (1) neurologic complications of VZV often are severe and continue to occur, not because of ineffective vaccine, but because of its suboptimal uptake; (2) vaccination of the majority of children has lessened circulation of VZV but has not eliminated exposure; and (3) the role of VZV should be considered for many neurologic conditions, especially in unimmunized individuals and even in the absence of a history of rash. Article page 779▶ Central Nervous System Complications of Varicella-Zoster VirusThe Journal of PediatricsVol. 165Issue 4PreviewTo describe the spectrum of central nervous system complications of varicella-zoster virus (VZV) in children admitted to The Hospital for Sick Children between January 1999 and December 2012. Full-Text PDF

Electroacupuntura en un caso de neuralgia postherpética con afectación de la rama oftálmica del V par craneal

Postherpetic neuralgia consists of chronic neuropathic pain that appears as a complication of varicella-zoster virus infection and is characterized by intense and episodic pain. The treatment of choice is pharmacological but adequate therapeutic response is not always achieved, either due to drug intolerance or to inadequate pain control. We report the case of a woman with postherpetic neuralgia affecting the left ophthalmic branch of the trigeminal nerve, in whom distinct drug treatments failed to achieve adequate pain control. Given this situation, electroacupuncture sessions were started, combined with pharmacological therapy. The frequency and intensity of the pain exacerbations progressively diminished, allowing drug treatment to be discontinued. Electroacupuncture can constitute a therapeutic alternative in patients with drug intolerance or inadequate control of neuropathic pain with pharmacological treatment.

P292 Central nervous system (CNS) complications of varicella-zoster virus infection: a retrospective 6 year review

P292 Central nervous system (CNS) complications of varicella-zoster virus infection: a retrospective 6 year review

Severe Guillain–Barré syndrome following primary infection with varicella zoster virus in an adult

Varicella zoster virus (VZV) infection may trigger Guillain-Barré syndrome (GBS), but this is rare and almost always in the context of reactivation disease from latent VZV, 'shingles'. We report here a case of severe GBS following primary VZV infection in an adult. A 40-year-old man of Indian origin developed features of GBS including quadriplegia, bulbar paralysis, and bilateral facial nerve palsies 14 days after primary VZV infection contracted from a known case in a family member. Nerve conduction studies confirmed acute inflammatory demyelinating polyneuropathy. Anti-ganglioside antibodies were negative. The mechanism of Schwann cell attack following VZV infection is poorly understood but this case suggests that primary VZV infection may be a sufficient stimulus to drive antibody generation and precipitate severe clinical symptomatology. The morbidity associated with the complications of VZV infection in adulthood could be avoided if patients who are seronegative for VZV (frequently from the Asian subcontinent) are offered prophylaxis after an exposure in adulthood.

Varicella Pneumonia: Another ‘Steroid Responsive’ Pneumonia?

Varicella-zoster virus (VZV) pneumonitis remains an often-fatal complication of VZV infection. Antiviral agents and supportive care are widely accepted therapies. Cautious use of corticosteroids in life-threatening VZV pneumonitis may be justified. Appropriate patient selection factors are as yet unidentified and the decision to commence corticosteroid therapy in this setting is clinical.

Granulomatous Vasculitis Associated With Herpes Virus: A Persistent, Painful, Postherpetic Papular Eruption

Cutaneous granulomatous vasculitis manifesting as a postherpetic reaction pattern is uncommon hand has previously been reported as a delayed complication of varicella-zoster virus infection. We describe three patients who had persistent, painful, postherpetic papules in a zosteriform distribution that histologically demonstrated a small vessel granulomatous vasculitis. Herpes simplex virus DNA detected by the polymerase chain reaction technique was demonstrated in two cases.

Varicella Zoster Virus Infections in Canadian Children in the Prevaccine Era: A Hospital-Based Study

To describe the clinical course of children admitted for varicella zoster virus (VZV) infections to a pediatric hospital before the release of VZV vaccine in Canada. Retrospective case series. Tertiary pediatric hospital. Population studied was children aged 18 years or younger admitted to hospital between 1983 and 1992 who were discharged with a diagnosis of varicella or zoster. Of the 201 children who were identified, 36 were excluded, leaving 165 for analysis. There was a male:female ratio of 1.5:1 and a median age of 5.3 years (range two weeks to 18 years). The group included those who were previously healthy (70, 42.4%), immunocompromised (60, 36.4%), and those with nonimmunocompromising conditions (35, 21.2%). Comparison of immunocompetent and immunocompromised children revealed that complication of VZV infection was a more common reason for admission among the former (86 of 105, 81.9%, P<0.001), whereas treatment with acyclovir to limit dissemination was the most common reason in the latter (53 of 60, 88.3%, P<0.001). Skin and soft tissue infections were the most common complications in immunocompetent children (36 of 98) and those younger than five years (26 of 53), whereas pulmonary complications predominated among immunocompromised patients (eight of 98) and neurological complications in five- to 10-year-olds (16 of 36). Only one death (0.6%) occurred in an immunocompetent patient. Group A beta-hemolytic streptococci and Staphylococcus aureus caused equal numbers of secondary infections (92% of all isolates). Complications of VZV infections and secondary prophylactic antiviral treatment of immunocompromised children explain the majority of hospitalizations in this institution, and can be monitored after VZV vaccine introduction. Complications vary significantly with underlying healthy status and age.

Southwestern Internal Medicine Conference: Pneumonias in Adults Due to Mycoplasma, Chlamydiae, and Viruses

Pneumonias in adults due to mycoplasma, chlamydiae, and viruses are a common clinical problem. These microorganisms contribute to the etiologies in 6–35% of all cases of pneumonia and are the sole pathogens in 1–17% of hospitalized cases. Important trends and developments in the field include (1) the emergence of a Chlamydia psittaci strain (TWAR) that is passaged from human to human, causes a mycoplasma-like illness, and that is relatively resistant to erythromycin, (2) the recognition of respiratory syncytial virus as a pathogen in nursing home outbreaks and in immunosuppressed adults, the continuing high lethality of fully developed influenza pneumonia, (4) the efficacy of acyclovir and adenine arabinoside in limiting the complications of varicella-zoster virus infections, and (5) the increasing frequency of pneumonia caused by cytomegalovirus and the severity of this disorder in highly immunosuppressed patients. Developments in the rapid diagnosis and therapy of respiratory syncytial virus infections with an aerosolized antiviral drug in children may pave the way for comparable advances in difficult pneumonias in adult patients.