Latent Varicella Zoster Virus Research Articles

Ramsay hunt syndrome: a case report

Ramsay hunt syndrome (RHS) is a neurological condition comprising of complications with varicella zoster virus (VZV) which results in inflammation of geniculate ganglion. In the days to weeks following zoster, various cranial nerve palsies can develop because the varicella-zoster virus is latent in the cranial nerve ganglia. The trigeminal and facial nerves were the most commonly affected by zoster, based on the cranial nerve involvement. Another common impacted nerve was the vestibulocochlear nerve. As VZV is exclusively human pathogen, research on VZV latency is limited to only human ganglia examination. This case report describes about Ramsay Hunt Syndrome induced or also called as Herpes Zoster Oticus caused by Varicella zoster virus. Diagnosis mainly involved laboratory investigations, patient history, treatment data and other relevant information co-related from various literature. A 46-year-old female patient was diagnosed Ramsay hunt syndrome on the basis of clinical findings as right facial palsy, blisters over right pinna, otalgia and right ear erythematous lesions. Patient also exhibited deviation of angle of mouth to left side and unable to close right eye. This was accompanied by elevated erythrocyte sedimentation rate (ESR) exhibiting acute inflammation. Hemoglobin was low and total leukocyte count was high. Following that, corticosteroids and antivirals were prescribed to assist her medical condition. Remission is slow for RHS, hence patient was also advised for rehabilitation therapy to improvise her lower motor neuron facial palsy. Recurrence is possible in long term so it is imperative to initiate early treatment within 72 hours as soon as the symptoms are observed for better patient care.

Orbital Myositis after Herpes Zoster Ophthalmicus: A Case Report and a Narrative Review of the Literature.

Herpes zoster ophthalmicus results from the reactivation of the latent varicella zoster virus, affecting the first branch of the trigeminal nerve. In 20-70% of cases, Zoster Ophthalmicus can lead to ocular involvement, affecting various orbital structures. Orbital myositis is a rare but severe complication of herpes zoster ophthalmicus. We present a case of a 52-year-old man with no significant medical history who developed zoster-associated right ocular myositis and dacryocystitis. He was treated with intravenous acyclovir and oral steroids. A review of the literature identified 29 patients across 19 studies. The median age was 61 years, with a slight female predominance. In 55% of cases, the patients had no notable medical history. The most common presentation of myositis involved all oculomotor muscles. There were 22 cases who were treated with intravenous antiviral therapy and 19 received steroids. A full resolution of symptoms was achieved in 51.7% of patients. Zoster-related orbital myositis is a rare complication that should be considered even in immunocompetent individuals. It may occur either before or after the appearance of a vesicular rash. Magnetic resonance imaging is the preferred radiological exam for assessing orbital involvement. Intravenous antiviral therapy should be started within 72 h of symptom onset, and its combination with systemic corticosteroids appears to be an effective treatment for zoster-related ocular myositis.

Zoster vaccination

Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to adecrease in specific Tcell-mediated immunity as aresult of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons ≥ 60years and for persons ≥ 50years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged ≥ 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome.

Lipo-pam™ adjuvanted herpes zoster vaccine induces potent gE-specific cellular and humoral immune responses

Herpes zoster (HZ), also known as shingles, is caused by the reactivation of latent varicella-zoster virus (VZV). Decreased VZV-specific T-cell immune responses significantly contribute to the development of HZ. Shingrix is a recombinant zoster vaccine that is currently used to prevent HZ. However, Shingrix has high reactogenicity and pain at the injection site due to QS21, one of the adjuvant components. In this study, we developed a new herpes zoster vaccine formulation called CVI-VZV-001, containing gE protein and a novel liposome-based adjuvant Lipo-pam™, which consists of two TLR agonists. We evaluated the immunogenicity of CVI-VZV-001 in mouse and rabbit models. CVI-VZV-001 elicited robust gE-specific T-cell immune responses and gE-specific antibody production. Specifically, CVI-VZV-001 induced polyfunctional CD4+ T cell populations that secrete multiple cytokines. Furthermore, CVI-VZV-001 sustained the gE-specific immune responses for up to six months after immunization. To ensure CVI-VZV-001’s safety for further development, we conducted a good laboratory practice (GLP) toxicity test, which confirmed that CVI-VZV-001 is safe for use. At present, CVI-VZV-001 is undergoing phase I clinical trials. This study suggests that CVI-VZV-001 can be a potent candidate for the HZ vaccine with high immunogenicity and safety.

Assessment of the herpes zoster risk among renal transplant recipients administered the influenza vaccine

BackgroundReactivation of the latent varicella-zoster virus can cause herpes zoster (HZ) infection, and renal transplant recipients undergoing immunosuppressive therapy are particularly susceptible to this condition. This study aims to evaluate the potential increase in HZ incidence following influenza vaccination among this specific patient population. MethodsThis study was a population-based, retrospective, self-controlled case series. Data were retrieved from Taiwan’s National Health Insurance Research Database spanning the years 2008 to 2017. Patients diagnosed with HZ within a 6-month period before and after receiving the influenza vaccine were eligible for inclusion. Two distinct time intervals were defined for analysis: the initial 15 days and 30 days following vaccination were categorized as risk intervals, while all other periods served as control intervals. Incidence rate ratios (IRRs) were computed to compare HZ incidence during the risk intervals with that during the control intervals. ResultsThis study encompassed a cohort of 4,222 renal transplant recipients who had received the influenza vaccine. Among this group, 67 recipients were subsequently diagnosed with HZ. The IRR during both the initial 15 days (IRR = 0.63; 95 % CI, 0.23–1.89) and the first 30 days (IRR = 1.50; 95 % CI, 0.71–3.16) following influenza vaccination did not demonstrate a statistically significant increase when compared to the post-exposure observation times. Comparable results were also observed when comparing these IRR values to the pre-exposure observation times. The subgroup analysis, stratified by age, sex, and underlying medical conditions (including cancer and autoimmune diseases), revealed that the IRRs did not exhibit statistically significant differences. ConclusionsNo significant association between the influenza vaccine and an elevated risk of HZ was detected. The administration of annual influenza vaccines appears to be a reasonable practice for renal transplant recipients.

Neuralgia Pasca Herpes

Herpes zoster, also known as snake pox and shingles , is a skin disease caused by reactivation of latent varicella zoster virus (VVZ) infection also known as human herpesvirus-3 (HHV-3) in the dorsal root sensory ganglion after primary infection. Mrs. A, 64 years old female was consulted with complaints of burning pain in the lower right abdomen to the right waist, that happened approximately 2 month after diagnosed with herpes zoster. Based on anamneses and physical examination the patient was diagnosed by Postherpetic neuralgia. Postherpetic neuralgia is persistent chronic pain and the most common complication in herpes zoster. In the majority of patients, pain from shingles is usually felt within 2 to 4 weeks. However, patients who experience NPH will experience continuous pain at the site of infection for 3 to 9 weeks after infection. The patients was given supportive treatment accompanied by education that can be provided to relieve the symptoms caused by this disease.

No Causal Effect of COVID-19 on Varicella-Zoster Infection, Herpes Zoster Progression, and Postherpetic Neuralgia: A Two-Sample Mendelian Randomization Study.

Coronavirus disease (COVID-19) may trigger the reactivation of the latent varicella-zoster virus and may be a risk factor for herpes zoster (HZ). However, the causal relationship between COVID-19 and varicella-zoster infections remains controversial. This study aimed to estimate the causal inferences between COVID-19 and HZ. This study used a two-sample Mendelian randomization (MR) design. The inverse variance-weighted method was used as the primary method and sensitivity analyses were conducted, including the MR-Egger regression, weighted median and weighted mode. We searched at https://gwas.mrcieu.ac.uk/ using the keywords "COVID-19" for exposure data and "zoster" for outcome datasets. We got 26 COVID-19 datasets and five zoster datasets. We used 26 COVID-19 datasets as exposure data corresponding to each zoster dataset for the MR analysis. There were nine datasets of COVID-19 where the number of SNPs was fewer than three in the MR analysis of the risk of HZ, varicella zoster virus (VZV) glycoprotein E and I antibody levels, anti-VZV IgG seropositivity, and post-zoster neuralgia. In addition, there were 10 datasets of COVID-19 where the number of SNPs was less than three in the MR analysis of anti-VZV IgG levels. The results of the MR analysis showed that all p-values were greater than 0.05. Sensitivity analysis revealed no evidence of horizontal pleiotropy in most two sample MR analyses. Our results indicate that there is no causal relationship between COVID-19 and varicella-zoster infection, HZ progression, and postherpetic neuralgia.

BioNTech COVID-19 (BNT162b2) Vaccination and Varicella Zoster Reactivation: A Comprehensive Cross-sectional Study.

Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus. Recent observations have suggested that HZ is associated with vaccination against COVID-19. To investigate the association between the vaccine and HZ severity, a single-centre, cross-sectional study of all patients diagnosed with HZ and 2 control diagnoses (cellulitis and bone fractures), between 2017 and 2021, was performed. Hospital visits and hospitalization rates were compared. All medical records of patients diagnosed with HZ in the first year after the COVID-19 vaccination campaign began were reviewed, in order to generate a retrospective cohort comparing vaccinated and unvaccinated patients with HZ. All participants had received the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. During the study period, 2,413 patients were diagnosed with HZ, and when normalized to control diagnoses the number of cases remained stable. The retrospective cohort included 365 patients. A multivariate analysis controlling for sex, age, autoimmune diseases, malignancies, and immunosuppressive therapy showed higher admission rates in vaccinated compared with unvaccinated individuals (odds ratio (OR) 2.75, 95% CI 1.27-5.96, p = 0.01). However, matching techniques and stratification by age, used to better control for confounders, invalidated these findings. No differences were observed in other variables indicative of disease severity (hospital stay length and complications). In conclusion, COVID-19 vaccination was not found to be associated with an increased risk of HZ-related admission and complications.

Herpes zoster ophthalmicus

Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.

Herpes Zoster in Palate: Atypical Presentation in Immunosuppressed Patient Secondary to Rituximab, a Case Report and Review of Clinical Manifestations and Management

Herpes zoster (HZ) is caused by the reactivation of the latent varicella zoster virus (vZv). The cause of reactivation may be associated with predisposing factors such as age, stress or the impaired immune system and an association with autoimmune diseases has been seen. Its clinical presentation is characterized by the appearance of multiple vesicles that rupture quickly, leaving small, very painful ulcers that are distributed respecting specific dermatomes. The diagnosis in most cases is clinical, and complementary tests may be necessary and differential diagnoses may be excluded in cases of atypical presentation. The main sequelae after the disappearance of skin signs is postherpetic neuralgia, which is more common in the elderly. Early diagnosis and rapid initiation of treatment determine the prognosis, especially in immunocompromised individuals. In this work we report a case of atypical clinical presentation in a woman with autoimmune disease, immunocompromised and belonging to the elderly population, being a clear example of the patient in whom special attention should be paid when establishing the diagnosis with the aim of emphasizing early detection and rapid establishment of appropriate treatment, avoiding deleterious outcomes.

Herpes zoster in an immunocompetent child: A case image

Herpes zoster (HZ) results from reactivation of latent varicellazoster virus primary infection (varicella). This condition appears to be less common in children and to have a favorable outcome in immunocompetent children. The diagnosis is clinical and the characteristic exanthema

Progressive shingles in a toddler due to reactivation of Varicella Zoster vaccine virus four days after infection with SARS-CoV-2; a case report

BackgroundHerpes zoster (HZ) is the clinical syndrome associated with reactivation of latent varicella-zoster virus (VZV). Several factors have been implicated to promote VZV reactivation; these include immunosuppression, older age, mechanical trauma, physiologic stress, lymphopenia, and more recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2). Recent reports suggest an increase in the number of HZ cases in the general population during the global COVID-19 pandemic. However, it is unknown what proportion of HZ during the pandemic is due to reactivation of wild-type or vaccine-strain VZV.CaseHere we report the first known case of HZ concomitant with SARS-CoV2 infection in a 20-month-old female who was treated with a single dose of dexamethasone, due to reactivation of the vaccine-type strain of VZV after presenting with a worsening vesicular rash.ConclusionIn this case, we were able to show vaccine-strain VZV reactivation in the context of a mild acute symptomatic COVID-19 infection in a toddler. Being able to recognize HZ quickly and effectively in a pediatric patient can help stave off the significant morbidity and mortality associated with disease process.

The immunogenicity and the safety of the adjuvanted glycoprotein E (gE)-based recombinant vaccine against herpes zoster (RZV) in cancer patients during immunotherapy

ABSTRACT Herpes zoster (HZ) is caused by the reactivation of latent varicella zoster virus (VZV). Severe immunocompromising conditions, such as solid tumors, have been largely associated with an increased risk for HZ due to waning VZV-specific cellular immunity. With the approval of the adjuvanted glycoprotein E (gE)-based recombinant vaccine (RZV; Shingrix™, GSK) also in immunocompromised subjects, HZ is considered a vaccine-preventable disease changing perspectives in immunocompromised subjects. To date, no clinical trial has evaluated the immunogenicity in the patients with cancer undergoing immunotherapy. In this study, we describe the humoral and cell-mediated immune responses in 38 cancer patients treated with immune checkpoint inhibitors (ICIs) and receiving RZV. We used samples collected at baseline (T0), 3 weeks (T2), and 6 months (T3) after the complete RV vaccination schedule. Our data showed that a significant proportion (40,5%) of RZV recipients mounted a stronger humoral and cell-mediated immune response at 3 weeks (T2) after complete RZV vaccination schedule. Interestingly, both humoral and cell-mediated immune responses were mostly stable over 6 months (T3). Interestingly, the overall IFNγ-producing lymphocytes was mainly associated with CD4 T cell response (p = .0012). In conclusion, data from our pilot study suggest a strong and long-lasting immunogenicity of RZV in ICI-treated patients. Prospective analyses at 1 year after vaccination will be performed in order to evaluate the long-term persistence of humoral and cell-mediated response against RZV.

Immunogenicity in Mice Immunized with Recombinant Adenoviruses Expressing Varicella-Zoster Virus Envelope Glycoprotein E.

Herpes zoster (HZ) is a disease caused by the reactivation of latent varicella-zoster virus (VZV). The subunit vaccine, Shingrix®, and live attenuated vaccine, Zostavax®, could be used as an HZ vaccine that prevents HZ from being developed due to the reactivation of latent VZV in the sensory ganglia due to aging, stress or immunosuppression. In this study, the recombinant adenoviruses rChAd63/gE expressing glycoprotein E (gE) of VZV based on chimpanzee adenovirus serotype 63 (ChAd63) were constructed and investigated for the immunogenicity of different immune pathways in C57BL/6 mice. The results showed similar CD4+ T and CD8+ T cell responses to Shingrix® were induced in mice vaccinated using rChAd63/gE via different immune pathways. This study elucidates that recombinant adenoviruses expressing VZV gE could be appropriate for further development as a new HZ vaccine candidate via different immune pathways.

Herpes zoster and postherpetic neuralgia progression rate: an epidemiological study at Tertiary Hospital in Bali, Indonesia

Link of Video Abstract: https://youtu.be/bmHkb4pnp9I Background: Herpes zoster is an infectious disease caused by the reactivation of the latent varicella zoster virus. One of the complications that has the potential to cause long-term problems is post-herpetic neuralgia. This study aims to evaluate the Herpes zoster and postherpetic neuralgia progression rate: an epidemiological study at Tertiary Hospital in Bali, Indonesia Methods: This is a retrospective descriptive cross-sectional study. The data was obtained from the patient's medical records in Dermatovenereology Clinic at Sanglah General Hospital Denpasar from January 2020 to December 2021. The samples were all new patients diagnosed with herpes zoster and post-herpetic neuralgia. The variable is sex, age, occupation, comorbid, and location. Data were analyzed using SPSS version 25.0 for Windows. Results: A total of 23 new patients were diagnosed with herpes zoster and the total visit was 132. Most patients were male 12 (52.3% vs 47.7%). The highest age group was more than 65 years old with 12 (51.5%) patients, followed by 45-64 years with 8 (35.6%) patients. The lesion location in most patients was thoracic in 9 patients (38.1%), followed by cervical in 7 patients (29.5%), lumbar in 6 patients (25.8%), and ophthalmic in 1 patient (6.6%). Six patients (26.0%) had comorbid diseases. Ten patients experienced PHN. Conclusion: Most herpes zoster patients in Dermatovenereology Clinic, Sanglah Hospital from January 2020 to December 2021 were more than 65 years old, predominantly male sex, with the most common location of herpes zoster in the thoracic region 9 patients (38.1%), and 10 patients (43.5%) had PHN.

No Varicella Zoster Virus Infection among Mpox Cases in Antwerp, Belgium.

Several studies in tropical settings have reported that ∼20% of patients infected with Monkeypox virus (MPXV) also tested polymerase chain reaction (PCR) positive for Varicella zoster virus (VZV). Researchers have hypothesized that VZV infection predisposes to monkeypox (mpox), or vice versa, or that MPXV triggers the reactivation of VZV. We tested samples for VZV from a cohort of patients infected with clade IIb MPXV diagnosed between May 23 and October 14, 2022 in Antwerp, Belgium. Leftover DNA extracts of skin lesion samples from 108 mpox patients were tested with in-house PCR for VZV. No VZV infections were found. The absence of concurrent VZV-MPXV infections in our cohort indicates that VZV did not cocirculate in the population at risk for MPXV during the Belgian 2022 outbreak, but also that MPXV does not commonly trigger reactivation of latent VZV in adult men.

Association between COVID-19 infection and herpes zoster: A case series

Herpes zoster (HZ) is a manifestation of the reactivation of latent varicella zoster virus (VZV) infection in the dorsal root ganglion. The occurrence of HZ has been reported in association with COVID-19. Herein, we describe 10 cases who developed classic HZ within 2–3 weeks of acquiring COVID-19 infection. The triggers in these patients could be severe stress (related to quarantine issues, fear of hospitalisation and death) immune dysregulation and systemic steroid therapy in treating COVID-19. The clinical patterns and therapeutic responses observed were similar to HZ in immunocompetent persons. Increased expression of NKG2A on NK and CD8+ T cells has been proposed as a pathophysiologic mechanism in triggering HZ at the molecular level in COVID-19 patients. Primary physicians should be aware of this association to counsel and treat such patients appropriately, as initiating early treatment could minimise the risk of complications like postherpetic neuralgia.

Multi metameric genital shingles A rare case in an immunocompetent child

Shingles is a viral dermatosis caused by the reactivation of the latent varicella zoster virus occurring usually after a primary varicella infection.

Hospitalization burden related to herpes zoster infection during the COVID-19 pandemic in Spain (2020-2021)

ABSTRACT Varicella-Zoster Virus (VZV) belongs to the family Herpesviridae. Herpes zoster (HZ) is caused by reactivation of latent VZV. It is associated with risk factors such as immunosenescence, immunosuppressive pathologies and pharmacological treatments. Patients with these risk factors are more likely to be hospitalized. Increases in HZ hospitalizations have been reported in many countries in recent years. The objective of this study is to estimate hospitalization rates, mortality rates and costs due to HZ during the worst years of the COVID-19 pandemic in Spain (2020–2021). This is a descriptive study based on an analysis of information from the Minimum Basic Dataset and coded according to the Spanish version of the 10th International Classification of Diseases (ICD-10-CM). Hospitalization, mortality and case-fatality rates, and median length of hospitalization were calculated.. The hospitalization rate was 14.4 cases per 100,000 inhabitants, and the mortality rate was 1.3 cases per 100,000 inhabitants. Both increased considerably with age. In this time period, 92.3% of the registered cases were people over 50 years of age. Nevertheless, during the COVID-19 pandemic period, hospitalization rate decreased and the mortality rate increased from previous years. HZ hospitalization and mortality rates are relevant issues in the public health of older people. It is highly recommended to evaluate new vaccination strategies against VZV to include the HZ vaccine for health care for elderly people, as well as to reduce the disease burden and associated risk factors. The estimation of HZ disease hospitalization costs were €100,433,904.

Herpes zoster vaccination recommendations ofthe group of experts of the Polish Society of Vaccinology,the Polish Society of Family Medicine, the Polish Societyof Dermatology, the Polish Association for the Studyof Pain and the Polish Neurological Society

Shingles is an infectious viral disease, a symptomatic reactivation of latent varicella-zoster virus infection (VZV). Its naturalhistory usually involves formation of blisters on erythematous skin, preceded by pain and encompassing the area of a singledermatome. Most vulnerable populations include individuals over 50 years of age as well as high-risk patients. Seriouscomplications can develop in the course of the disease, with post-shingles neuralgia being the one of the highest clinicalimportance; it develops in as many as 30% of all patients, resulting in considerable suffering and reduction in the qualityof life. The treatment of post-shingles neuralgia is lengthy and frequently inefficient, posing a significant challenge forhealthcare systems. Vaccinations are the most efficient form of protection against shingles and its related complications.Due to the epidemiology of infections and their complications, vaccinations are recommended in all individuals over the ageof 50 as well as in younger adults (18 years or older) with the disease risk factors.