Detection Of Varicella-zoster Virus Research Articles

Case of acute retinal necrosis with rapid progression to proliferative vitreoretinopathy: A case report.

Acute retinal necrosis (ARN) was first reported in 1971 by Urayama et al as an acute uveitis accompanied by retinal arteritis and white retinal lesions in the peripheral retina that can progress to a rhegmatogenous retinal detachment (RRD). We have experienced a case of ARN that, unlike the common developmental course to an RRD associated with ARN, progressed to proliferative vitreoretinopathy (PVR) involving the entire retina in 2 days. The purpose of this report is to present our findings in the case of ARN with an atypical rapid time course. The patient was a 56-year-old woman who was treated for uveitis of unknown origin by her primary care physician. She was referred to our hospital because of a worsening of the fundus findings. Fundus examination in our hospital revealed vitreous opacities in the right eye, yellowish-white lesions extending around the retina, and some retinal hemorrhages. Because the retinal changes suggested ARN, we performed a polymerase chain reaction of the anterior atrial fluid and detected varicella-zoster virus. Then, the diagnosis of ARN was confirmed, and treatment was begun. At 1 month and a half after beginning the treatment, focal retinal traction was observed in the right fundus. Two days later, a circumferential PVR and a total retinal detachment were detected. We then performed vitrectomy with an encircling buckle and a silicone oil tamponade. Our examination 6 months postoperatively showed that the retina was attached and the BCVA was 20/200. Our findings of a case of ARN showed that the progression from a local vitreous traction to a full circumferential PVR can develop in 2 days.

Rapid detection of varicella-zoster virus based on an immunochromatographic strip

Varicella-zoster virus (VZV) is a highly infectious DNA virus that can cause varicella (chickenpox) and herpes zoster (HZ). A simple, sensitive and specific detection method is desirable for the VZV infection. In this study, VZV gE protein, expressed in CHO cells, was used to immunize BALB/c mice for the generation of monoclonal antibodies (mAbs). For the first time, we developed a colloidal gold-based immunochromatographic strip for rapid detection of VZV using a pair of mAbs against gE protein. The limit of detection (LOD) of the strip was 30 ng mL−1 of purified VZV gE antigen, and it could specifically test VZV without cross-reactivity with Enterovirus 71 (EV-71), Herpes simplex virus 1 (HSV-1) and Herpes simplex virus 2 (HSV-2). The coincidence rate between the strip and commercial real-time PCR diagnostic kit was 100% using vesicle as the clinical sample. Our strip provided a technical support for rapid and specific detection of VZV.

Prevalence and clinical relevance of VZV lung detection in intensive care unit: A retrospective cohort study.

To assess the clinical relevance of varicella zoster virus (VZV) lung detection among patients hospitalized in intensive care unit (ICU). We present a monocentric retrospective cohort study from 2012 to 2020. VZV genome was detected in bronchoalveolar lavage (BAL) fluid by real-time PCR. Twelve of 1389 (0.8%) patients exhibited VZV lung detection, corresponding to an incidence of 13.4 (95% confidence interval [CI] 5.8-21.0) per 100 person-years. Immunosuppression and prolonged ICU stay constituted the main risks factors. VZV detection was not associated with pulmonary deterioration but associated with a risk of shingles occurrence during the following days. VZV lung detection is a rare event among ICU patients, occurring mostly in immunocompromised patients with prolonged ICU stay. Due to its scarcity and the lack of association with pulmonary failure, a targeted approach to the VZV lung detection diagnosis may allow a significant cost saving without affecting the quality of patients care.

Herpes zoster ophthalmicus: frequency and risk factors for developing uncommon ocular manifestations

ObjectifDéterminer la fréquence de l'herpès zoster ophtalmique (HZO), communément appelé « zona ophtalmique », et évaluer les facteurs de risque d'apparition de manifestations oculaires peu fréquentes de l'HZO confirmé par analyse de laboratoire. NatureÉtude de cohorte rétrospective. MéthodesLa fréquence de l'HZO, comparativement à l'ensemble des cas d'herpès zoster, a été calculée d'après les codes de la Classification internationale des maladies attribués aux patients examinés au centre médical de l'Université de Pittsburgh entre le 1er janvier 2004 et le 31 octobre 2021. Nous avons en outre recueilli les données démographiques et cliniques des patients atteints de zona ophtalmique chez lesquels la présence du virus varicelle-zona a été objectivée par la réaction en chaîne de la polymérase (PCR) entre le 1er janvier 2011 et le 31 décembre 2020. RésultatsLa fréquence des cas d'HZO diagnostiqués entre 2004 et 2021 chez les patients de tous âges se chiffrait à 4,2 %, le taux annuel étant de 2,7 % à 6,7 %. Les taux ont systématiquement augmenté de 2,9 % par année entre 2012 et 2021. Après la mise en marché du vaccin à virus vivant contre le zona en 2008, la fréquence des diagnostics d'HZO a diminué de 5,1 % entre 2008 et 2012 chez les patients de 60 ans et plus. Dans un échantillon de 50 cas d'HZO diagnostiqué par PCR, 62 % des sujets avaient des manifestations oculaires fréquentes sur le plan clinique, dont la plupart étaient des cas de kératite (n = 13) et d'uvéite antérieure (n = 10). Enfin, la majorité des manifestations peu fréquentes du zona ophtalmique étaient des cas de nécrose rétinienne aiguë (n = 15; 38 %), lesquels qui étaient significativement plus susceptibles de se produire en cas d'immunodépression (rapport de cotes non ajusté : 4,55; intervalle de confiance à 95 % : 1,29–13,83). ConclusionsEntre 2004 et 2021, la fréquence globale d'HZO était de 4,2 %, pourcentage qui a augmenté tous les ans depuis 2012. Les manifestations oculaires peu fréquentes du zona ophtalmique diagnostiqué par PCR consistent surtout en la nécrose rétinienne aiguë et sont plus susceptibles de se produire chez des patients immunodéprimés.

CRISPR-based quantum dot nanobead lateral flow assay for facile detection of varicella-zoster virus.

Varicella-zoster virus (VZV) infects more than 90% of the population worldwide and has a high incidence of postherpetic neuralgia in elderly patients, seriously affecting their quality of life. Combined with clustered regularly interspaced short palindromic repeats (CRISPR) system, we develop a quantum dot nanobeads (QDNBs) labeled lateral flow assay for VZV detection. Our assay allows the identification of more than 5 copies of VZV genomic DNA in each reaction. The entire process, from sample preparation to obtaining the results, takes less than an hour. In 86 clinical vesicles samples, the test shows 100% concordance with quantitative real-time PCR for VZV detection. Notably, when vesicles are present in specific areas, such as the genitals, our method outperforms clinical diagnosis. Compared to traditional detection methods, only a minute amount of blister fluid is required for accurate detection. Therefore, we anticipate that our method could be translated to clinical applications for specific and rapid VZV detection. KEY POINTS: • CRISPR/Cas12a and quantum dot nanobead-based lateral flow assay achieved 5 copies per reaction for VZV detection • Specific identification of VZV in atypical skin lesions • Results read by the naked eye within one hour.

Overlapping Signs and Symptoms Between Recurrent Varicella and Pityriasis rosea Gibert.

Pityriasis rosea Gibert (PRG) has features similar to those of common infectious childhood diseases, suggesting a viral cause, but no agent has been identified to date. We describe 4 children with PRG and 2 with recurrent varicella who were studied using photochronography, virology and immunology. The 6 patients with skin rashes visited our pediatric clinic from April 2012 to May 2016. Photographs of their skin lesions were taken; blood, skin lesions, and/or nasal lavage samples were collected to detect varicella-zoster virus (VZV) DNA and antibodies; and skin tests were carried out to measure cell-mediated immunity to VZV. Herald patches were confirmed in 2 of 4 PRG patients. No specimen cultures were positive for infectious VZV. However, VZV-DNA was detected in skin lesions of 3 PRG patients. During the acute phase, 5 patients had IgG antibodies to VZV, and skin-test reactions were positive in 5 patients. IgG antibody titers to VZV at rash onset were high, suggesting that they were already rising at the appearance of the rash and that reinfection with VZV must have occurred during the prodromal stage or several weeks before rash appearance in PRG patients whose immunity had declined below the threshold. Our study suggests a new pathogenesis of PRG that might help to address incongruities of past theories on PRG sites of viral entry and replication, incubation period and variations in the clinical course of PRG from prodrome to healing.

Metagenomic Next-Generation Sequencing vs. Traditional Microbiological Tests for Diagnosing Varicella-Zoster Virus Central Nervous System Infection.

BackgroundUnbiased metagenomic next-generation sequencing (mNGS) detects pathogens in a target-independent manner. It is not well-understood whether mNGS has comparable sensitivity to target-dependent nucleic acid test for pathogen identification.MethodsThis study included 31 patients with chickenpox and neurological symptoms for screening of possible varicella-zoster virus (VZV) central nervous system (CNS) infection. Microbiological diagnosing of VZV cerebrospinal fluid (CSF) infection was performed on stored CSF samples using mNGS, quantitative and qualitative VZV-specific PCR assays, and VZV IgM antibodies test.ResultsThe median age was 30.0 [interquartile range (IQR), 24.3–33.3] years. 51.6% of the patients were men. About 80.6% of the patients had normal CSF white blood cell counts (≤ 5 × 106/L). VZV IgM antibodies presented in 16.1% of the CSF samples, and nucleic acids were detectable in 16.1 and 9.7% using two different VZV-specific real-time PCR protocols. Intriguingly, maximal identification of VZV elements was achieved by CSF mNGS (p = 0.001 and p = 007; compared with qualitative PCR and VZV IgM antibody test, respectively), with sequence reads of VZV being reported in 51.6% (16/31) of the CSF samples. All VZV PCR positive samples were positive when analyzed by mNGS. Of note, human betaherpesvirus 6A with clinical significance was unexpectedly detected in one CSF sample.ConclusionsOur study suggests that CSF mNGS may have higher sensitivity for VZV detection than CSF VZV PCR and antibody tests, and has the advantage of identifying unexpected pathogens.

An atypical case of viral endotheliitis

<br>A 48-eight-year-old male presented with redness and blurred vision in his right eye for the past 10 days, sudden in onset, with circumciliary congestion and corneal edema. On examination localized disciform corneal edema, with multiple keratic precipitates, was seen and diagnosed as corneal endotheliitis. Specular microscopy showed endothelial morphological changes with pseudoguttae. Anterior chamber paracentesis subjected to polymerase chain reaction detected varicella zoster virus. He was treated with topical 3% acyclovir gel, homatropine eye drops, 1% prednisolone acetate, and 0.5% timolol maleate. Prednisolone acetate was tapered over 14 weeks. His visual acuity at presentation was 6/36, which improved to 6/9 after 4 weeks of treatment and the final visual acuity was 6/6.<br>

Design and evaluation of a multiplex vesicular rash PCR for the detection of varicella zoster virus and herpes simplex virus

Varicella zoster virus (VZV) typically infects the skin leading to chickenpox (varicella) and herpes zoster whereas herpes simplex virus 1 and 2 (HSV-1/-2) often affect the mucosa forming herpes labialis and genital herpes. However, in eczema herpeticum and herpes gladiatorum, HSV infections occur on the skin. The cutaneous infections with VZV or HSV often present similar clinical manifestations causing trouble in differentiation.

Characteristics and Long-term Prognosis of Danish Patients With Varicella Zoster Virus Detected in Cerebrospinal Fluid Compared With the Background Population.

Risk factors for, and long-term outcomes following, detection of varicella zoster virus (VZV) DNA in the cerebrospinal fluid (CSF) are unknown. We performed a nationwide population-based cohort study of all Danish residents who had VZV DNA detected in the CSF by polymerase chain reaction (PCR) between 1 January 1997 and 1 March 2016 (VZV cohort; n = 517) and an age- and sex- matched comparison cohort from the general Danish population (n = 9823). We examined potential risk factors and mortality, neurologic morbidity, psychiatric morbidity, redemptiom of prescriptions for nervous system medicine prescribed for the nervous system, and social outcomes. Prior hospital admission, redemption of immunosuppressive medicine, comorbidity, and immunosuppressive conditions were associated with detection of VZV DNA in the CSF. Mortality was increased in the VZV cohort, especially during the first year of observation and among patients with encephalitis. Patients in the VZV cohort had an increased risk of dementia and epilepsy. The redemption of antiepileptics and antidepressants was increased in the VZV cohort. Immunosuppression and comorbidity are associated with increased risk of detection of VZV DNA in the CSF and the condition is associated with increased mortality and neurological morbidity.

Sensitivity and specificity of different antibody tests for detecting varicella-zoster virus

IntroductionAntibody tests for detecting varicella-zoster virus include the fluorescent-antibody-to-membrane-antigen (FAMA) assay, immune adherence hemagglutination assay (IAHA), enzyme immunoassay (EIA), and the glycoprotein-based enzyme-linked immunosorbent assay (gpELISA). Although FAMA and gpELISA are highly sensitive, FAMA is not available commercially. Therefore, this study was performed to compare potential high-sensitivity tests with commercially available tests. MethodsFour antibody tests, FAMA, gpELISA, EIA, and IAHA, were performed using sera collected from 32 children aged 7 months–10 years. Using FAMA as a reference, the sensitivity and specificity of gpELISA, EIA, and IAHA were assessed. Subsequently, using gpELISA as a reference, the positive agreement rate of EIA and IAHA was assessed. ResultsOn a reference scale with FAMA set at 100%, the sensitivity and specificity of the antibody tests were as follows: gpELISA, 67% and 100%; EIA, 67% and 100%; and IAHA, 47% and 100%, respectively. The positive agreement rates of EIA and IAHA relative to gpELISA were 86% and 64%, respectively.Conclusions: gpELISA had a lower positive rate than did FAMA, and showed comparable sensitivity to that of EIA.

Encephalitis due to herpes zoster without rash in an immunocompetent 12-year-old girl: case report and review of the literature

BackgroundNeurological complications due to reactivation of varicella-zoster virus (VZV) are very uncommon in immunocompetent patients. Generally a vesicular rash is present on one or more dermatomes, preceding or following the main manifestation. Few cases are reported in the international literature, but they concern mainly adult or elderly patients.Case presentationA 12-year-old girl was referred to our hospital for persisting headache, cough and rhinitis for six days. After first examination, diagnosis of anterior sinusitis was made by nasal endoscopy. The day after, the girl developed psychotic symptoms and altered mental status. Computed tomography (CT) scan was immediately performed but was unremarkable; lumbar puncture revealed leukocytosis with lymphocytic predominance and cerebrospinal fluid polymerase chain reaction (PCR) detected varicella-zoster virus DNA. The diagnosis of acute VZV encephalitis was made. The patient was promptly treated with acyclovir infused intravenously and her clinical conditions rapidly improved. Tests made did not show any condition of immunosuppression.ConclusionsAlthough if rare, reactivation of VZV can occur in immunocompetent children and its complications can involve central nervous system. Among these complications, meningitis is more common, but cerebral parenchyma can also be involved leading to a severe medical condition that is defined meningoencephalitis. In rare cases vesicular rash may be absent; therefore high level of suspicion is required even in those patients in which suggestive clinical features are not present to guide the diagnosis. Intravenous acyclovir represents the treatment of choice to obtain a fast clinical response and to prevent the onset of late-term complications.

Varicella-Zoster Virus infected human neurons are resistant to apoptosis.

Varicella-zoster virus (VZV) is a pathogenic human herpesvirus that causes varicella (chickenpox) as a primary infection following which it becomes latent in ganglionic neurons. Following viral reactivation many years later VZV causes herpes zoster (shingles) as well as a variety of other neurological syndromes. The molecular mechanisms of the conversion of the virus from a lytic to a latent state in ganglia are not well understood. In order to gain insights into the neuron-virus interaction, we studied virus-induced apoptosis in cultures of both highly pure terminally differentiated human neurons and human fetal lung fibroblasts (HFL). It was found that (a) VZV DNA did not accumulate in infected human neurons; (b) VZV transcripts were present at lower levels at all days studied post-infection in neurons; (c) Western blot analysis showed less VZV IE 63 and very little detectable VZV gE proteins in infected neurons compared with HFL; (d) lower levels of the apoptotic marker cleaved Caspase-3 protein were detected in VZV-infected neurons compared with HFL, and higher levels of the known anti-apoptotic proteins Bcl2, Bcl-XL and also the mitochondrial MT-CO2 protein were found in VZV-infected neurons compared with uninfected cells; and (e) both the MT-CO2 protein and VZV IE 63-encoded protein were detected in infected neurons by dual immunofluorescence. These findings showed that neurons are resistant to VZV-induced apoptosis, which may have relevance to the switching of VZV from a lytic to latent ganglionic neuronal infection.

Assessment for varicella zoster virus in patients newly suspected of having giant cell arteritis.

There is uncertainty if varicella zoster virus (VZV) triggers GCA. This is based on discordant reports of VZV detection in GCA temporal artery biopsies. We conducted a multimodal evaluation for VZV in the inception Giant Cell Arteritis and PET Scan (GAPS) cohort. Consecutive patients who underwent temporal artery biopsy for suspected GCA were clinically reviewed for active and past VZV infection and followed for 6 months. Serum was tested for VZV IgM and IgG. Temporal artery biopsy (TAB) sections were stained for VZV antigen using the VZV Mouse Cocktail Antibody (Cell Marque, Rocklin, CA, USA). A selection of GCA and control tissues were stained with the VZV gE antibody (Santa Cruz Biotechnology, Dallas, TX, USA), which was used in previous studies. A total of 58 patients met inclusion criteria, 12 (21%) had biopsy-positive GCA and 20 had clinically positive GCA. None had herpes zoster at enrolment and only one patient developed a VZV clinical syndrome (zoster ophthalmicus) on follow-up. There was no difference in VZV exposure between GCA and non-GCA patients. None of the 53 patients who had VZV serology collected had positive VZV IgM antibodies. VZV antigen was not convincingly demonstrated in any of the TAB specimens; 57 TABs stained negative and 1 stained equivocally positive. The Santa Cruz Biotechnology VZV antibody exhibited positive staining in a range of negative control tissues, questioning its specificity for VZV antigen. The absence of active infection markers argues against VZV reactivation being the trigger for GCA. Non-specific immunohistochemistry staining may account for positive findings in previous studies.

DISCREPANCIES IN BRONCHIAL WASH AND LAVAGE: THE DUBIOUS CASE OF VARICELLA PNEUMONIA

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Varicella pneumonia is a rare but serious infection caused by Varicella Zoster virus (VZV). Diagnosis is attained by clinical presentation, radiologic findings & is aided by detection of VZV in respiratory secretions by polymerase chain reaction (PCR). We present a diagnostic dilemma when two tests have a discrepancy. CASE PRESENTATION: A 41 year old female presented with left upper quadrant (LUQ) abdominal pain, hypotension, melena & somnolence which prompted intubation. She had medical history of end stage liver disease due to alcoholic cirrhosis, esophageal varices, refractory ascites & encephalopathy. Endoscopy showed varices & small bowel ulcer; & paracentesis ruled out bacterial peritonitis. After treatment with octreotide, nexium & prophylactic ceftriaxone; she was was successfully extubated. 3 days later, she developed a new, vesicular, dermatomal rash of shingles on LUQ. This was followed by new extensive multifocal infiltrates, crazy paving pattern & diffuse ground glass opacities on chest imaging (Figure) along with hypoxic respiratory failure which warranted re-intubation. A bronchoscopy was done which showed thick white secretions on bronchial washing (BW) & cloudy fluid on bronchoalveolar lavage (BAL) of right middle lobe & left upper-lingular segment. VZV PCR resulted positive on BW but negative on BAL. Patient was started on Varicella-Zoster immune globulin (VZIG) and acyclovir based on clinical presentation and radiologic features which led to clinical improvement. DISCUSSION: Varicella pneumonia can manifest 1-6 days after onset of the typical rash & is highly infectious with a secondary attack rate of > 90%. In the presence of clinical features of VZV infection, the diagnosis is mediated by chest imaging showing nodular or interstitial pneumonitis with ground glass opacities. Molecular diagnostic assays using PCR are often employed and have sensitivity as high as 96% for detection of VZV (1). However, it can be limited by false positive rate due to contamination and depends on the methodology (2) as well as specimen source although BAL has high sensitivity (3). Our patient developed respiratory failure with radiologic findings shortly after typical zoster rash. Despite adequate sampling, there was a discrepancy in the result obtained from BAL and BW. A comparison of these two hasn’t been studied yet in respect to VZV as well as other common pathogens. We favored to treat the patient due to detection of VZV on BW & the clinical presentation. VZIG administration within 72 hours of exposure is highly efficacious for disease prevention in immunocompromised along with intravenous acyclovir for 7-10 days and has led to overall decline in mortality. CONCLUSIONS: Although VZV DNA detection by PCR is helpful in diagnosing VZV pneumonia, there is no consensus data on its utility on BW in comparison to BAL. The paucity of VZV pneumonia is a hindrance for more extensive studies. Reference #1: Mirouse A et al. Severe varicella-zoster virus pneumonia: a multicenter cohort study. Critical Care. 2017 Dec;21(1):137 Reference #2: Schmutzhard J, Riedel HM, Wirgart BZ, Grillner L. Detection of herpes simplex virus type 1, herpes simplex virus type 2 and varicella-zoster virus in skin lesions. Comparison of real-time PCR, nested PCR and virus isolation. Journal of clinical virology. 2004 Feb 1;29(2):120-6 Reference #3: Stránská R, Schuurman R, de Vos M, van Loon AM. Routine use of a highly automated and internally controlled real-time PCR assay for the diagnosis of herpes simplex and varicella-zoster virus infections. Journal of Clinical Virology. 2004 May 1;30(1):39-44 DISCLOSURES: No relevant relationships by Enambir Josan, source=Web Response No relevant relationships by Supriya Singh, source=Web Response No relevant relationships by Yasir Tarabichi, source=Web Response

Varicella Zoster Virus Vasculitis and Adult Cerebrovascular Disease.

The role of Varicella zoster virus (VZV) in neurological illness, particularly cerebrovascular disease, has been increasingly recognized. Primary infection by VZV causes varicella (chickenpox), after which the virus remains latent in neuronal ganglia. Later, during aging or immunosuppression, the virus can reactivate causing zoster (shingles). Virus reactivation can also spread to cerebral arteries causing vasculitis and stroke. Zoster is a recognized risk factor for stroke, but stroke can occur without preceding zoster rash. The diagnosis of VZV cerebral vasculitis is established by abnormal brain imaging and confirmed by presence of viral DNA or anti-VZV antibodies in cerebrospinal fluid. Treatment with acyclovir with or without prednisone is usually recommended. VZV vasculitis is a unique and uncommon stroke mechanism that has been under recognized. Careful diagnostic investigation may be warranted in a subgroup of patients with ischemic stroke to detect VZV vasculitis and initiate appropriate therapy. In the following review, we detail the clinical presentation of VZV vasculitis, diagnostic challenges in VZV detection, and suggest the ways to enhance recognition and treatment of this uncommon disease.

Detection of varicella-zoster virus from cerebrospinal fluid using advanced fragment analysis in a child with encephalitis: a case report

BackgroundVaricella zoster virus (VZV) encephalitis is an infectious inflammatory disease of brain that can cause irreversible mental damage without timely treatment. In fact, many viruses can cause encephalitis, and the viral loads in cerebrospinal fluid (CSF) in the early stage of the disease are usually too low to be detected. Here we report a case of VZV encephalitis diagnosed by advanced fragment analysis (AFA), which could potentially to contribute to early diagnosis of VZV central nervous system (CNS) infections with a small volume of CSF samples.Case presentationA 10-year-old boy was admitted to the hospital with obvious neurological symptoms of headache, dizziness and vomiting for one day. Physical examination showed left facial paralysis. Complete blood count (CBC) test only showed an unspecific inflammation, and the culture of cerebrospinal fluid and microscopic staining examination were all negative. AFA was performed to screen the common 18 encephalitis related pathogens in CSF. Obvious VZV DNA fragments were observed by capillary electrophoresis at 160 nt, suggesting the existence of VZV CNS infection in children. The results were consistence with real-time quantitative PCR and concomitant symptoms in the acute stage of the disease.ConclusionsWe report a case of acute VZV encephalitis in a child without obvious skin manifestations, which was rapidly diagnosed by AFA. Overall, we would recommend the use of AFA analysis as the rapid screening system for the identification and differentiation of encephalitis pathogens in children.

Varicella Zoster Virus Detection from the Crust using by Derma Quick® VZV

Varicella Zoster Virus Detection from the Crust using by Derma Quick® VZV

Investigation of an Outbreak of Varicella in Chandigarh, North India, Using a Real-time Polymerase Chain Reaction Approach

Outbreaks of varicella are reported when susceptible population accumulates. This study reports a chickenpox outbreak in Burail in August 2014, wherein 20 laboratory-confirmed cases were identified by the detection of varicella zoster virus (VZV) DNA and VZV IgM antibodies. The viral load between vesicular swabs and serum samples from 8 patients with active lesions was found to have good correlation and further also related with disease severity. Real-time polymerase chain reaction can be useful for early diagnosis of an outbreak and vesicular swab can be used as a less invasive sample for assessing the disease severity.

No detection of varicella-zoster virus in temporal arteries of patients with giant cell arteritis.

Data on the presence of varicella-zoster virus (VZV) in temporal arteries of patients with giant cell arteritis (GCA) are controversial. We analyzed VZV infection in temporal arteries from Italian patients with temporal artery biopsy (TAB)-positive GCA, TAB-negative GCA, and controls. A total of 79 formalin-fixed, paraffin-embedded (FFPE) TABs performed between 2009 and 2012 at a single institution from 34 TAB-positive GCA patients, 15 TAB-negative GCA patients, and 30 controls were retrieved. Six 5-μm sections of all FFPE TABs were cut. The first section was analyzed by immunohistochemistry using mouse monoclonal anti-VZVgE IgG1 antibody. DNA was extracted from the remaining five sections and analyzed by real-time polymerase chain reaction (PCR) for the presence of VZV DNA. For 10 of the 34 TAB-positive GCA patients, an additional 2-mm piece of frozen TAB was available. DNA was extracted from the entire 2-mm length frozen specimen and analyzed by PCR for the presence of VZV DNA. Thirty additional 5-μm sections were cut from the FFPE TABs of these 10 patients and analyzed by immunohistochemistry for the presence of VZV antigen. Immunohistochemical analysis detected VZV antigen in 1/34 (3%) TAB-positive GCA, 0/15 TAB-negative GCA, and 0/30 controls, and in none of the 300 sections cut from the 10 FFPE TABs positive for GCA for which the frozen specimens were available. DNA obtained from all TABs was amplifiable. VZV DNA was neither found in any of the FFPE TABs nor found in frozen TABs. Our data do not support in Italian patients a possible role for VZV infection in the etiopathogenesis of GCA.