Reactivation Of Varicella Zoster Virus Research Articles

The Spectrum of Neurological Manifestations of Varicella-Zoster Virus Reactivation.

Varicella-Zoster virus (VZV) is a pathogenic human alpha herpes virus that causes varicella (chicken pox) as a primary infection and, following a variable period of latency in different ganglionic neurons, it reactivates to produce herpes zoster (shingles). The focus of this review is on the wide spectrum of the possible neurological manifestations of VZV reactivation. While the most frequent reactivation syndrome is herpes zoster, this may be followed by the serious and painful post-herpetic neuralgia (PHN) and by many other neurological conditions. Prominent among these conditions is a VZV vasculopathy, but the role of VZV in causing giant cell arteritis (GCA) is currently controversial. VZV reactivation can also cause segmental motor weakness, myelitis, cranial nerve syndromes, Guillain-Barre syndrome, meningoencephalitis, and zoster sine herpete, where a neurological syndrome occurs in the absence of the zoster rash. The field is complicated by the relatively few cases of neurological complications described and by the issue of causation when a neurological condition is not manifest at the same time as the zoster rash.

Pathophysiology and treatment of pain in multiple myeloma

Most patients with multiple myeloma (MM) suffer from chronic pain of varying degrees of intensity at every stage of the natural disease process. Osteolytic bone lesions are one of the most common complications of MM. The bone disease visualized by PET/CT and MRI affects up to 90% of newly diagnosed MM patients, increasing the risk of the development of skeletal-related events. Pathological fractures and spinal cord compression occur in 17% and 6% of patients, respectively. Bone pain is explained by an increase in pressure in the bone marrow, the release of chemical mediators by myeloma plasma cells, and the occurrence of microcracks in the bones, indirectly to a violation of local metabolism. Management of myeloma bone disease includes anti-myeloma chemotherapy and radiotherapy, antiresorptive therapy with bisphosphonates or denosumab, and direct pharmacological pain correction. Patients with pathological vertebral fractures and without spinal cord compression should be considered for vertebroplasty or kyphoplasty. The use of proteasome inhibitors and monoclonal antibodies for the treatment of MM is associated with a risk of herpes simplex virus (HSV) and varicella-zoster virus (VZV) reactivation. The result of the healing of herpetic eruptions in some patients will be the development of postherpetic neuralgia, manifested by excruciating pain for months or years. Moreover, the treatment with proteasome inhibitor bortezomib is often associated with the development of long-term persistent peripheral neuropathy, often complicated by pain. According to their neurobiological and clinical features, pain is classified into nociceptive, neuropathic, and functional. Bone pain is nociceptive and for postherpetic and chemotherapy-induced neuropathy, the neuropathic component is more significant. Opioids are the drugs of choice for moderate to severe nociceptive pain, while anticonvulsants and antidepressants are the most commonly used adjuvants for neuropathic pain. This review summarizes information on the pathophysiology of various types of pain syndrome in patients with MM, as well as on modern approaches to the prevention and treatment of complications. The issues of the pharmacology of opioid analgesics are discussed. The review concludes with data from a clinical trial of a new domestic non-opioid μ1-opioid receptor agonist Tafalgin, considered a real alternative to narcotic analgesics.

Herpes zóster cutáneo. Epidemiología y características clínicas en un centro hospitalario de tercer nivel

IntroductionShingles is an infectious dermatosis, caused by reactivation of varicella zoster virus (VZV). There is little information regarding clinical and epidemiological characteristics, in patients with immunosuppression. MethodologyThe objective of this article is to describe the clinical characteristics, associated comorbidities and incidence of period in hospitalized patients in a third level reference hospital with shingles’ diagnosis. A case review was carried out in the period between January 2021 and January 2023. ResultsOf a total of 54 cases, 66.6% were women and 33.3% men; the average presentation age was 51.4 years, 35.2% were ≥ 60 years old, in those who presented immunosuppression, it was less than 50 years; The four most frequent associated comorbidities were autoimmune diseases 46.3%, 20.4% neoplasms, type 2 diabetes mellitus 11.1% and HIV infection 7.4%. The 55.5% had a localized presentation and in 44.4% it was disseminated, 18.5% presented at least one complication, the most frequent was keratoconjunctivitis. The cervical dermatomes were the most affected. Mortality was 1.9%. ConclusionsShingles in patients with immunosuppression occurs at earlier ages and more frequently in a disseminated way.

Estimation levels of (IL-4, IL-12, and IL-17) and other immunological characteristics in Herpes zoster patients in the southern Iraqi \province of Thi-Qar

Varicella-zoster virus (VZV), which was dormant in the dorsal root ganglia or cranial nerve, reactivates to produce the viral illness shingle. Immunosenescence, which includes the documented decline of cell-mediated immunity with aging, can result in in the VZV reactivation. While HZ is typically mild in young, persons who are in good health, while older individuals are more likely to experience complications. The present study was carried out during the months of July 2022 to January 2023 in the governorate of Thi-Qar We examined the levels of VZV IgG antibodies, IL-4, IL-12,IL-17 and checking level VTN in the blood of 70 HZ patients who did not suffer from superinfection. 30 individuals of a comparable age who were healthy and free of infectious and inflammatory diseases made up the control group. blood samples were collected from them and examined via the ELISA system. While the plasma vitronectin level dropped in HZ patients when in comparison to the control group, both the serum levels of the cytokines IL-4, IL-12, and IL-17 as well as the VZV IgG antibody titer considerably rose. According to the results, HZ patients without chronic illnesses had significantly greater levels of IL-17. compared to individuals suffering from chronic illnesses. Additionally, IL-12 levels were noticeably higher in females than in males. Age and sex differences were not found to be significantly different in the research.

PA34 A case of disseminated herpes zoster in an immunocompetent child

Abstract Herpes zoster (HZ) caused by the reactivation of varicella-zoster virus (VZV) affects mainly the adult population. The incidence is low in children (0.45 cases per 1000 individuals annually), especially in the immunocompetent. It is said to be disseminated when there are > 20 lesions outside the primary and adjacent affected dermatome. We present this case to highlight a rare complication of cutaneous dissemination in a previously healthy child with HZ, following in utero exposure to varicella at 28 weeks’ gestation. A 15-year-old boy presented with painful blisters in the T2 dermatome of 1 week’s duration, which later spread to trunk, extremities and face. This was associated with fever and neuralgia. There was no previous history of varicella and no recent contact history. He had no significant past medical history and was not on any medications. Antenatal history revealed that his mother had varicella at 28 weeks’ gestation and was treated with aciclovir. He was febrile on admission (39°C). There were coalesced vesiculopustules and crusted lesions with marked perilesional erythema in the T2 dermatome. In addition, disseminated vesicular lesions were seen on the trunk, extremities and face. Remaining systemic examination was unremarkable. C-reactive protein was elevated. Complete blood count and renal function tests were normal. Liver function tests, namely alanine transaminase and γ-­glutamyl transferase were elevated. Blood culture showed no growth. Varicella-zoster IgG was positive. Viral swab (polymerase chain reaction) from the skin lesions was positive for varicella-zoster DNA. Infectious serology for HIV, hepatitis B and hepatitis C was negative. Antinuclear antibody and antineutrophil cytoplasmic antibodies were negative. A clinical diagnosis of HZ with cutaneous dissemination was made, and he was treated with intravenous aciclovir. Intravenous antibiotics were added for suspected secondary bacterial infection. Disseminated zoster is less common in children and mainly occurs in patients with underlying immunodeficiency like HIV, immunosuppressive drug use or malignancy. In immunocompetent children, this can happen when primary infection (varicella) has occurred in utero or the first year of life due to the low response in specific varicella-zoster virus immunity. Complications like cutaneous dissemination due to viraemia are rare in healthy children, but can affect 2–10% of immunocompromised patients. It occurs 3–4 days after the onset of dermatomal lesions. It is important to look for other complications, especially in the immunocompromised, as viraemia can affect the brain, kidneys, lung and liver. Sequelae like postherpetic neuralgia is rare, but it is important to follow-up these children to look for its development.

Systematic Literature Review of Herpes Zoster Disease Burden in Southeast Asia.

Herpes zoster (HZ; i.e., shingles) is caused by the reactivation of varicella zoster virus leading to a painful dermatomal rash. An increasing trend in cases of HZ is evident worldwide; however, there is a lack of comprehensive reviews for Southeast Asian countries. We performed a systematic literature review of articles published until May 2022 that reported HZ epidemiology, clinical management, and health economic data in six Southeast Asian countries: Indonesia, Malaysia, the Philippines, Singapore, Thailand, and Vietnam. Literature searches were conducted in Medline, Scopus, Embase, and gray literature. Articles written in English or local languages were considered for inclusion. In total, 72 publications were included in the study; 22 were case studies and over 60% originated in Singapore and Thailand. Only two studies (data from Thailand) reported incidence of HZ. The proportion of patients reported with HZ was 0.68-0.7% among dermatology clinics, 0.14% at one emergency department (5.3% of dermatology cases) in Singapore, and 3% of admissions at another hospital in Singapore. Pain was the most common symptom associated with HZ, reported in 74.21-100% of patients. HZ complications were reported in 10.2-21.2% of patients, and the proportions with postherpetic neuralgia and HZ ophthalmicus were 6.3-50% and 4.98-28.57%, respectively. Additionally, there is a lack of comprehensive, up-to-date HZ economic data, with only six studies identified for the Philippines, Singapore, and Thailand. Overall, there are limited data reporting incidence and prevalence of HZ in Southeast Asia at a national level. High rates of complications, symptoms, and abundance of case reports suggest substantial healthcare resource utilization for patients with HZ and highlight the need for further research in Southeast Asia assessing the societal impact.

Homoeopathic Treatment of Childhood Herpes Zoster—A Case Series

Abstract Background Herpes zoster (HZ) is a relatively rare infectious disease in the paediatric population as compared to adults, occurring due to the reactivation of latent varicella-zoster virus that persists in the posterior root ganglion. HZ can develop any time after the primary infection and is characterised by grouped vesicular rashes limited to single dermatome. Diagnosis is based on a distinct clinical appearance of HZ. Its clinical course is variable, and it requires prompt medical treatment to prevent the complications. In conventional method, antiviral and other treatment modalities are available; however, these are fraught with potentially severe side effects and is expensive that demands an alternative method of treatment. Methods A case series of three children with HZ treated with individualised homeopathy is presented here. The cases are reported according to HOM-CASE guidelines and followed up with photographic documentation. The Modified Naranjo Criteria for Homeopathy (MONARCH) inventory was used as a tool for assessing the causal relationship between homeopathic intervention and clinical outcome. Results All cases of HZ were successfully cured with individualised homoeopathy within 10 days without any complication. Individual curative response of the homoeopathic medicine in each case was assessed through MONARCH which demonstrated a positive causal attribution of homeopathy. Conclusion Successful results of this case series suggest a positive response of individualised homeopathic medicines in the treatment of childhood HZ. The remissions of the HZ lesion presented in this case series may be attributed to homeopathic medicines in each case. Hence, this case series could serve as a basis for further research into the role of individualised homeopathic medicine in the treatment of childhood herpes zoster.

Atypical Presentation of Herpes Zoster: A Clinical Case Report

Introduction: Herpes zoster, which is infected with varicella zoster virus (VZV), is a neurological infection and an immunodeficiency syndrome. Most patients who contact physicians complain of itchy and sometimes painful skin rashes. Herpes zoster, also known as "shingles," results from the reactivation of VZV in the dorsal ganglia. Most skin patches occur on the hands or abdomen; rashes on the feet are rare. We aimed to report Herpes zoster presentation in the foot. Case Presentation: A 47-year-old male patient presented to private practice with a rash, itching, and pain in the left lower extremity for 3 days. He was diagnosed with herpes zoster and symptoms were relieved by the administration of acyclovir five times daily for one week. The patient was advised to use Calamine lotion, a cool bath, and a cold compress to relieve the pain and itching. On his next visit to the office, the rash on the left lower extremity disappeared after using the prescriptions and methods. Conclusion: Considering that the prevalence of herpes zoster in the hands and feet is very low and only 7 cases have been reported in the world. This case was reported for the first time in Iran. Knowing the presentation of the disease and getting to know the patients' complaints can help in timely diagnosis and control.

Meningitis in the Course of Herpes Zoster Ophthalmicus in an Immunocompetent Boy.

To the Editors: Herpes zoster tends to be recognized as a regional manifestation of varicella-zoster virus (VZV) reactivation, but it might be accompanied by complications in the central nervous system, such as cranial nerve palsies, meningoencephalitis or myelitis. Meningitis in the course of VZV reactivation in immunocompetent children is very rare, showing an incidence of 5.4% in children with zoster.1 VZV travels also to the arterial adventitia, and thus, it may lead to vascular complications. Zoster ophthalmicus in particular can lead to the involvement of the cerebral arteries and subsequent stroke.2 A 12-year-old boy presented to the emergency room with suspicion of herpes zoster ophthalmicus. Six days before admission, the patient developed a fever >39 °C, a left-sided headache, followed by 2 episodes of vomiting. Three days before the admission, the patient’s mother noticed vesicular lesions on the left upper eyelid and eyebrow (Fig. 1). The boy had no history of head trauma nor any gait/balance disturbances. He had been diagnosed with varicella at the age of 2 weeks (direct contact with a sibling suffering from chickenpox). The patient reported no chronic diseases, no recurrent infections or loss of weight. The patient had been consulted in the Pediatric emergency room 1 day before the admission and had been referred to an ophthalmologist. On the day of admission, the ophthalmologist diagnosed him with herpes zoster ophthalmicus, but no further investigations were undertaken. On admission to our department, the patient was under a fair general condition, GCS 15, with normal vital signs, with an adequate psychological condition. Vesicular lesions on an erythematous basis without signs of bacterial superinfection were found on the left upper eyelid, the left eyebrow, and the left frontotemporal region. Some of the lesions were in the stage of crusts. His head was tender on palpation in the regions of C2-C3 dermatomes. Submandibular lymph nodes were enlarged to 1.5 cm. Meningeal and cerebellar signs were negative. No nuchal rigidity was observed. No other abnormalities were found on physical examination. Blood analysis showed no abnormalities except for slight domination of lymphocytes in the peripheral blood smear. Inflammatory markers were low. Cerebrospinal fluid (CSF) analysis revealed pleocytosis of 223 (94% lymphocytes), with normal protein and glucose levels. Multiplex PCR testing of CSF detected DNA of VZV. Diagnosis of zoster meningitis was established. Intravenous acyclovir in the dosage of 500 mg/m2 every 8 hours was implemented for 10 days. The patient was discharged home in good general condition with no neurologic complications.FIGURE 1.: Herpes zoster ophthalmicus lesions before admission to the hospital.In the study by Petursson et al, patients were followed for up to 6 years and no association between the risk of undiagnosed malignancy and shingles in childhood was found. We want to highlight that collecting thorough history of a patient is sufficient for selecting patients at the risk of neoplasms or immune deficiencies and broad laboratory testing, imaging studies or invasive investigations are not indicated in children with zoster.3 This article draws attention to the early recognition of zoster and even more its complications in immunocompetent children.

Comparative evaluation of the clinical presentation and epidemiology of the 2022 and previous Mpox outbreaks: a rapid review and meta-analysis

Background In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarised and compared the findings from published observational studies on the clinical presentation and epidemiology of the 2022 and previous outbreaks of Mpox. Methods We registered a review protocol with the Open Science Framework (osf.io/j3kb7). We searched MEDLINE, Embase, CENTRAL, CINAHL and Scopus databases, and relevant websites up to August 30, 2022. Retrieved literature citations were screened for eligibility, and summary clinical presentation and epidemiological data from the included studies were pooled, when possible, using an inverse variance, random-effects model. Results Seventy-nine studies met the eligibility. Irrespective of outbreak, fever, headache, myalgia, lymphadenopathy, pleomorphic skin lesions, oral lesions, and sore throat were potentially highly relevant Mpox manifestations, while conjunctivitis, cough, and possibly reactivation of varicella zoster virus may be part of the clinical presentation. The mean incubation period for the 2022 outbreaks was 7.4 d (6.4–8.4 d, I 2 64.2%; 4 studies: 270 cases) and for previous outbreaks, 12.9 d (10.4–15.5 d; one study: 31 cases), p < .001. None of the male cases from previous outbreaks was reported to have sex with men (MSM) whereas almost all reported male cases from the 2022 outbreak were MSM. Concomitant sexually transmitted infections and perianal lesions were reported only among male cases from the 2022 outbreak, with the cases mostly presenting with genital lesions. Conclusions The 2022 Mpox outbreaks appear to be mostly among MSM and have a lower incubation period compared with previous outbreaks. Key messages 79 studies met the review’s inclusion criteria. The 2022 Mpox outbreaks appear to have shorter incubation period compared with previous outbreaks. Established clinical presentation of Mpox includes fever, headache, myalgia, lymphadenopathy, pleomorphic skin lesions, oral lesions, and sore throat. Almost all reported cases from the 2022 Mpox outbreaks were men who had sex with men (MSM). Concomitant sexually transmitted infections and perianal lesions were only reported among cases from the 2022 Mpox outbreaks. A significantly higher proportion of Mpox cases from the 2022 outbreaks had genital lesions compared with cases from previous outbreaks. The 2022 Mpox outbreaks appear to be mostly among MSM.

Treatment with Brivudine in Immunocompromised Pediatric Patients with Herpes Zoster

Introduction: Herpes zoster (HZ) is caused by endogenous reactivation of latent varicella-zoster virus (VZV) that persists in sensory ganglia after primary infection. The incidence and severity of HZ increase during immunosuppression. Especially, immunocompromised patients are at high risk of developing a cutaneous rash and suffering from delayed healing of lesions. Bromovinyl deoxyuridine (brivudine), one of the most potent oral inhibitors of VZV replication, is widely used in the therapy of HZ in adult patients, particularly in Europe. In this study, we investigated the efficacy of brivudine in immunocompromised children to provide an outpatient treatment option. Methods: In this retrospective study, we included 64 immunocompromised pediatric patients with a median age of 14 years. Forty-seven patients received immunosuppressive therapy as part of hematopoietic stem cell transplantation and 17 patients as part of chemotherapy. Primary diagnosis was made clinically by examining the nature and the localization of the skin lesions. Laboratory confirmation was conducted based on the detection of VZV DNA in vesicle fluid and blood samples. Brivudine was administered orally at a single dose of 2 mg/kg per day. We monitored the patients’ response for the full time of treatment and observed the time of full crusting of lesions, loss of crusts, and any adverse effects that occurred. Results: Patients received medication for 7–21 days (median: 14 days). All children responded promptly to antiviral treatment and recovered completely from their HZ infections without complications. Crusting of lesions was reached after 3–14 days (median: 6 days). Full healing of skin lesions was ascertained within 7–21 days (median: 12 days). Overall, brivudine therapy was well tolerated. No clinical side effects during or after the treatment were observed. High compliance was achieved due to the once-daily dosing regimen. All patients were treated in an outpatient manner. Conclusion: Oral brivudine was a very effective and well-tolerated therapy in immunocompromised children with HZ infection. The oral administration offers the potential for outpatient treatment of HZ in these patients.

Reactive infectious mucocutaneous eruption secondary to SARS‐CoV‐2 and influenza A coinfection with varicella zoster virus reactivation

AbstractReactive infectious mucocutaneous eruption (RIME) is a newly proposed clinical entity characterised by post‐infectious mucositis involving two or more mucous membranes. The term expands the previously described Mycoplasma pneumoniae‐induced rash and mucositis to include additional infectious agents. We report a case of RIME secondary to SARS‐CoV2 and Influenza A coinfection with subsequent reactivation of varicella zoster virus on the lips. RIME can have significant clinical overlap with Stevens‐Johnson Syndrome and differentiation is key in limiting unnecessary future medication restrictions on patients. This report serves to increase awareness of RIME, including to coinfections and possible reactivation of Human Herpes Viruses.

Multiple cranial neuropathy due to varicella zoster virus reactivation without vesicular rash: a challenging diagnosis.

Ramsay Hunt syndrome is due to reactivation of varicella zoster virus (VZV) dormant in the geniculate ganglion of the facial nerve. The diagnosis is typically based on clinical triad of ipsilateral facial paralysis, otalgia, and vesicles in the auditory canal or the auricle. However, Ramsay Hunt syndrome may occur without skin eruption in up to onethird of patients. Moreover, the involvement of other cranial nerves in addition to the facial nerve has been also reported. Herein, we reported a case report of a man who developed a multiple cranial neuropathy caused by VZV reactivation without skin vesicular eruption. The present case underlines a possible diagnostic challenge that clinicians may hit when facing a common disorder such as peripheral facial palsy. Indeed, clinicians must be aware that Ramsay Hunt syndrome may develop without skin vesicular eruption as well it may be complicated by multiple cranial nerve involvement. Antiviral therapy is effective in VZV reactivation for recovery of nerve function.

Pole-to-pole involvement of varicella zoster virus reactivation following COVID-19 vaccination.

The aim of this study is to report the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management outcomes in a series of three cases of varicella zoster virus (VZV) reactivation following one dose of coronavirus disease 2019 (COVID-19) vaccination. This was a retrospective and observational study. All the patients who developed uveitis post-vaccination were pooled together. Patients who had VZV reactivation were included. Two cases had polymerase chain reaction positive for VZV from aqueous humor. At the time of presentation, IgG and IgM spike protein antibodies for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were tested. Out of this pool, three patients with classical features to describe pole-to-pole manifestations were chosen. A 36-year-old lady with post-vaccination sclerokeratouveitis associated with reactivation of herpes zoster ophthalmicus, a 56-year-old lady with post-vaccination acute anterior uveitis associated with herpes zoster ophthalmicus, and a 43-year-old gentleman with post-vaccination acute retinal necrosis were included. We present a possible link between anti-SARS-CoV-2 virus vaccination and varicella zoster reactivation in these patients and also describe the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management with detailed discussion.

Herpes zoster duplex bilateralis asymmetrica

Varicella zoster virus (VZV) causes varicella and herpes zoster (HZ). Lesions are commonly unilateral and dermatomal, but rarely more than one contiguous or two noncontiguous widely separated dermatomes may be involved. HZ duplex bilateralis (HZDB) is a very rare pattern and is indicative of some underlying immunosuppression. A 65-year-old female presented with multiple, grouped fluid-filled vesicles and crusted lesions over an erythematous base bilaterally in dermatomal distribution over the right upper limb (C8, T1) and left lower limb (L2, L3) since 3 days associated with pain, itching, and burning sensation. She was diagnosed as a case of HZ duplex bilateralis asymmetrica and treated with antivirals and supportive treatment. HZ is caused by reactivation of VZV remaining latent in the dorsal nerve root ganglion due to cell-mediated immunity after primary infection. Old age, recent mechanical trauma, and subsequent psychological stress might impair cell-mediated immunity can be implicated as a trigger for reactivation of VZV.

Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV), and Cryptococcal Infections Associated With Sphingosine-1-Phosphate Receptor (S1PR) Modulators: A Review (P12-10.005)

<h3>Objective:</h3> To summarize the existing data on the incidence of herpes simplex virus (HSV), varicella-zoster virus (VZV), and Cryptococcus sp. infections with sphingosine-1-phosphate receptor (S1PR) modulators. <h3>Background:</h3> S1PR modulators are a novel class of disease-modifying therapies for multiple sclerosis (MS) that produce immunosuppression and potential lymphopenia. Herpesvirus and cryptococcal diseases were the most common opportunistic infections in clinical trials. Several post-hoc analyses have subsequently been published with revised incidence rates (IRs) for these conditions. <h3>Design/Methods:</h3> A literature review and descriptive analysis of phase-3 trials (n=6), post-marketing studies (n=8), and case reports (n=17) were conducted using PubMed and Google Scholar. Further data was accessed through Novartis AG, Bristol-Myers Squibb, and Janssen Pharmaceuticals. <h3>Results:</h3> <h3>FINGOLIMOD:</h3> Herpesvirus infection rates were similar between placebo (2.8%) and 0.5 mg (2.1%) but increased with 1.25 mg (5.5%) in the TRANSFORMS study. VZV rates were higher with fingolimod 0.5 mg (3.0%; 11 per 1000 patient-years [PY]) than with placebo (1.0%; 6 per 1000 PY), but comparable post-marketing. Cryptococcal infections (n=74) had an IR of 9 per 100,000 PY, and 13 cases were individually reported. <h3>SIPONIMOD:</h3> VZV reactivation occurred more frequently with siponimod (2%) than with placebo (1%); EXPAND extension analyses calculated an IR of 0.9 for HSV and 1.8 for VZV infections. One case of cryptococcal meningitis (from 7236 PY of exposure) was documented. <h3>OZANIMOD:</h3> An integrated safety analysis reported oral herpes at 1.5%, VZV at 1.4%, and HSV at 0.5% from all clinical trials versus 0.7%, 0.6%, and 0.1% from the phase-3 trials. The IR of herpes zoster was 5.3/1000 PY. <h3>PONESIMOD:</h3> The incidence of herpetic infections was equal between both groups (4.8%) in the OPTIMUM trial. Cryptococcal infections have not yet been reported with ozanimod or ponesimod. <h3>Conclusions:</h3> Overall, the incidence of these opportunistic infections associated with S1PR modulators in MS was low, with favorable outcomes and limited fatalities. <b>Disclosure:</b> Dr. Sharma has nothing to disclose. Mr. JHA has nothing to disclose. Dr. Khanal has nothing to disclose. Dr. Sriwastava has nothing to disclose.

Effect of Herpes Zoster Treatment and Sudden Sensorineural Hearing Loss Using National Health Insurance Claims Data of South Korea.

Background and objectives: Herpes zoster (HZ) is caused by the reactivation of a pre-existing latent varicella zoster virus, which is one of the viruses that causes hearing loss, and hearing loss may occur due to a systemic immune response even if it does not invade the auditory nerve. This study aimed to determine the correlation between sudden sensorineural hearing loss (SSNHL) in older adult patients who received HZ treatment. Materials and Methods: We used the cohort data of patients aged 60 years and above (n = 624,646) between 2002 and 2015 provided by the National Health Insurance Service. The patients were divided into two groups: those who were diagnosed with HZ between 2003 and 2008 (group H, n = 36,121) and those who had not been diagnosed with HZ between 2002 and 2015 (group C, n = 584,329). Results: In the main model (adjusted HR = 0.890, 95% CI = 0.839-0.944, p < 0.001) adjusted for sex, age, and income, and the full model (adjusted HR = 0.894, 95% CI = 0.843-0.949, p < 0.001) adjusted for all comorbidities, group H had a lower risk of SSNHL than group C. Conclusions: This study showed that patients who received HZ treatment had a lower incidence of SSNHL within five years after diagnosis.

Zoster Sine Herpete: two unusual cases of varicella-zoster reactivation with atypical complaints of acute chest pain and severe headache

In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. After the initial workup ruled out cardiac and musculoskeletal etiologies, the characteristic dermatomal distribution of pain made us suspect VZV reactivation. A diagnosis of ZSH was made with positive VZV IgG and IgM serologies and symptomatic relief after famciclovir treatment. In Case 2, a 43-year-old woman presented with a severe headache and resolved sharp right flank pain. She was diagnosed with varicella meningitis after cerebrospinal fluid showed positive VZV DNA. Intravenous acyclovir treatment resulted in symptom resolution. The most common presentation of VZV reactivation is Herpes Zoster, or shingles, making ZSH a frequently missed diagnosis. High clinical suspicion is warranted to prevent life-threatening complications of ZSH.

Herpes zoster in a 4-year-old child with pulmonary tuberculosis: a case report

Herpes zoster (HZ) is a dermatomal virus infection caused by the reactivation of latent varicella zoster virus (VZV) in sensory ganglia neurons that is previously exposed to primary varicella infection. Herpes zoster is a rare disease experienced in children and is often associated with an immunocompromised condition. A case of a girl four years old with a vesicle on the right chest which spread to the upper armpit and right inguinal was reported. The lessions were obtained on Thoracoaxilla as high as T4 and Inguinal as high as L1 dextra. The patient was treated with acyclovir doses of 30 mg/Kg/day for seven days and showed significant improvements.

Severe varicella-zoster virus meningoencephalomyelitis coexisting with visceral disseminated varicella-zoster virus infection in a patient with lupus nephritis: A case report

Meningoencephalomyelitis and visceral dissemination infection are rare but life-threatening complications of either the primary infection or reactivation of varicella-zoster virus (VZV) in immunocompromised patients. To date, few studies have reported the co-existence of VZV meningoencephalomyelitis and the visceral dissemination of VZV infection. A 23-year-old male was diagnosed with lupus nephritis class III and was being treated with oral prednisone and tacrolimus. The patient exhibited herpes zoster 21-day after the initiation of therapy and experienced unbearable abdominal pain and generalized seizures 11 days after the onset of a zoster rash. Magnetic resonance imaging showed progressive lesions in the cerebrum, brainstem, and cerebellum, as well as meningeal thickening and thoracic myelitis. Computed tomography showed pulmonary interstitial infiltration, partial intestinal dilatation, and effusion. Metagenomic next-generation sequencing revealed 198,269 and 152,222 VZV-specific reads in the cerebrospinal fluid and bronchoalveolar lavage fluid, respectively. Based on the clinical and genetic findings, this patient was finally diagnosed with VZV meningoencephalomyelitis and visceral disseminated VZV infection. The patient received intravenous acyclovir (0.5 g every 8 hours) combined with plasma exchange and intravenous immunoglobulin. Treatment against secondary bacterial and fungal infections, organ support therapy and rehabilitation training were given simultaneously. The patient's peripheral muscle strength did not improve and repeated metagenomic next-generation sequencing showed the persistence of VZV-specific reads in the cerebrospinal fluid. The patient finally abandoned therapy due to financial constraints at the 1-month follow-up. Patients with autoimmune diseases receiving immunosuppressive therapy should be warned about the possibility of developing serious neurological infections and visceral disseminated VZV infections as side effects. Early diagnosis and the early initiation of intravenous acyclovir therapy are important for such cases.