Localized Zoster Research Articles

Herpes zoster at the NIH: A 20 year experience

One hundred and seven cases of herpes zoster in a hospitalized population with a variety of illnesses during a 20 year period were reviewed. Zoster occurred throughout the year, without seasonal predominance, and was most frequent in lymphoproliferative malignancy. In the majority, lesions were confined to the skin in one or more adjacent dermatomes (localized zoster) and were most frequent in the thoracic region. In 15 per cent of the cases, cutaneous dissemination of the lesions developed; this occurred four to 11 days after the onset of dermatomal lesions, and in one-third of these there was central nervous system involvement. Dissemination of zoster, however, directly resulted in only one death. Predisposing factors for zoster included local irradiation and, occasionally, surgery in subsequently involved areas. There were trends for more frequent splenectomies in patients with Hodgkin's disease in whom zoster subsequently developed, and for more frequent corticosteroid therapy in patients with disseminated zoster. Advanced stage of Hodgkin's disease, in itself, was not associated with development of zoster, and the onset of zoster did not herald a poor prognosis for the underlying disease. Herpes zoster was, thus, largely a source of increased morbidity rather than mortality in the population studied, and multiple factors appeared to predispose to the development of zoster in this group of patients.

Effect of Transfer Factor and Zoster Immunoglobulin in Patients with Varicella-Zoster Infection and Malignancy

Immunotherapy was given to 13 patients suffering from lymphoproliferative diseases complicated by varicella-zoster (VZ) infection. Five patients received transfer factor (TF) only, 6 received TF and zoster immunoglobulin (ZIG), and 2 received ZIG only. ZIG did not seem to alter the course of the infection. Cessation of vesicle formation and initiation of crust formation took place within 1 day after the first injection of TF in 5 patients with a localized zoster. In 4 patients suffering from an early dissemination of VZ infection, cessation of vesicle formation took place within 1 day (1 patient), 2 days (1 patient), 3 days (1 patient) or 4 days (1 patient) after the first injection of TF. An increase in serum interferon was observed in 4 of 9 patients who received TF, while no increase in serum interferon was observed in the control groups. Administration of a high-titer ZIG preparation did not seem to depress the humoral antibody response when combined with TF therapy. Therapy with TF in combination with ZIG seemed to have a beneficial effect in patients with malignancy when administered early in the acute VZ infection.

Varicella-Zoster Immunoglobulins during Varicella, Latency, and Zoster

Antibodies to membrane antigens of cells infected by varicella-zoster virus were detected by immunofluorescence. Rises in varicella-zoster IgA, IgG, and tigM were detected after both varicella and zoster. Prompt antibody responses were observed in patients with generalized zoster as well as in those with localized zoster. A delayed response was found, moreover, in one patient who did not develop disseminated disease. Antibody to varicella-zoster virus was detected in the sera of all three patients tested prior to and in all but one of 63 patients tested soon after onset of zoster. The level of varicella-zoster IgA and IgG rose in two of three immune patients after household exposure to infection with varicella-zoster virus. Varicella-zoster IgG was detected in the cord blood of infants whose mothers were immune to varicella.

Zoster, reinfection or activation of latent virus?: Observations on the antibody response

An epidemiologic investigation of 108 patients with zoster revealed that (1) only four had a possible recent exposure to varicella or zoster, (2) there was no increase in zoster cases corresponding to the seasonal peak of varicella, and (3) the fewest cases of zoster were contributed by subjects with the greatest likelihood of being exposed to varicella. These observations indicate that reinfection did not play a significant role in the causation of zoster. Patients with localized zoster had an anamnestic type of antibody response, confirming the putative thesis that these subjects had been exposed previously to varicella-zoster antigen. The character of the response suggested that passive immunization of these patients would not be indicated. Two of the five patients with generalized zoster, in contrast, had a delay in the appearance of antibody. The failure to observe a delay in all five patients, however, suggested that this may be but a single manifestation of a more profound immunologic defect in these subjects. An epidemiologic investigation of 108 patients with zoster revealed that (1) only four had a possible recent exposure to varicella or zoster, (2) there was no increase in zoster cases corresponding to the seasonal peak of varicella, and (3) the fewest cases of zoster were contributed by subjects with the greatest likelihood of being exposed to varicella. These observations indicate that reinfection did not play a significant role in the causation of zoster. Patients with localized zoster had an anamnestic type of antibody response, confirming the putative thesis that these subjects had been exposed previously to varicella-zoster antigen. The character of the response suggested that passive immunization of these patients would not be indicated. Two of the five patients with generalized zoster, in contrast, had a delay in the appearance of antibody. The failure to observe a delay in all five patients, however, suggested that this may be but a single manifestation of a more profound immunologic defect in these subjects.