Varicella Zoster Infection Research Articles

Varicella zoster infection in Pediatric oncology patients in Hue Central Hospital, Vietnam

Abstract Background Varicella zoster infection in pediatric oncology patients presents a big challenge. It could lead to a severe, prolonged and disseminated infection with complications in multiple organs. This study aimed to investigate varicella zoster infection in pediatric oncology patients at Hue Central Hospital, Vietnam in order to describe demographic, epidemiological, clinical features and complications. Methods Varicella zoster infections among children with cancer were identified between January 8 to November 4, 2023, at Hue Central Hospital. Varicella zoster infection was diagnosed clinically based on the presence of typical skin manifestations. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results From January 8 to November 4, 2023, a total of 20 patients with malignancies were identified as having varicella zoster, with a median age of 3.5 years (range: 1 years to 16 years). All these patients did not received varicella zoster vaccine. Almost half of the patients had solid tumor (n=11, 55.0%), and other half had leukemia (n=9, 45.0%). Some of them (n=7, 35.0%) were receiving chemotherapy, and other (n=13, 65%) just finished chemotherapy. Most children were hospitalized (n=16, 80.0%) and they were given oral acyclovir (n=18, 90.0%). Three children (15.0%) required critical care (severe infection, acute pancreatitis, and multiorgan failure (MOF)), and one (5.0%) died from disseminated and progressive varicella with MOF and suspected varicella zoster meningitis. Chemotherapy was delayed or omitted due to varicella in 70.0%. Some of the children with varicella acquired from their parents. There were 5 parents who got varicella zoster when taking care patients at the hospital. All patients were likely to expose other patients in the wards. Conclusion Children with cancer are at extra risk of varicella zoster infection and progression to severe disease due to their immunocompromised status. Optimizing vaccination of care providers, such as their relatives, will prevent transmitting virus to the patients.

Infection risk with JAK inhibitors in dermatoses: a meta-analysis.

Evolving evidence suggests that Janus Kinase Inhibitors (JAKi) may predispose to certain infections, including tuberculosis and human herpes viruses. This review aimed to compare the infection risk in patients on a systemic JAKi for a dermatologic indication to a placebo. A systematic review was carried out from inception to June 2023, using the EMBASE, Medline, SCOPUS, and Cochrane Library of Registered Trials databases. Eligible studies included placebo-controlled randomized trials that investigated the incidence of infection in patients with a dermatologic indication. Primary outcomes included the most commonly reported infections pertaining to serious and opportunistic infections, upper respiratory tract infections, nasopharyngitis, herpes simplex, varicella zoster, tuberculosis, neutropenia, and lymphopenia. A meta-analysis of incidence ratios was conducted to determine odds ratios (OR), with a 95% confidence interval (CI) analysis. The meta-analysis found no increased risk of serious (OR: 0.92, 95% CI: 0.61-1.43, P = 0.74) or opportunistic infections (OR: 0.65, 95% CI: 0.32-1.31, P = 0.23). The incidence of varicella-zoster infections was significantly higher in the JAKi cohort (OR: 1.72, 95% CI: 1.08-2.72, P = 0.022). From 25 studies, there was no overall increased risk of herpes simplex infections (OR: 1.43, 95% CI: 0.93-2.23, P = 0.102) to placebo; however, a significantly higher risk in those with atopic dermatitis to alopecia areata was demonstrated (OR: 1.73, 95% CI: 1.13-2.69, P = 0.013). The results of this analysis do not suggest an increased risk of serious and opportunistic infections in those on JAKi compared to placebo. However, they support an increased risk of varicella-zoster infections and a higher risk of herpes simplex infections in those with atopic dermatitis to alopecia areata. The results of this report support these agents' short-term safety but signal that vigilance should be practiced in patients at risk for serious or recurrent herpes virus infections.

Acute osteomyelitis and varicella-zoster infection: Is there a relation?

Acute osteomyelitis and varicella-zoster infection: Is there a relation?

Overlapping Miller Fisher Syndrome Following Primary Varicella Zoster Infection: A Case Report

Overlapping Miller Fisher Syndrome Following Primary Varicella Zoster Infection: A Case Report

Utilizing Technology to Fill the Ambulatory Care Communicable Disease Practice Gap

Background: Infection Prevention (IP) practices in ambulatory care are often reactive and many communicable diseases in the community often do not fall onto IP’s radar until the patient becomes ill enough to seek inpatient services. The gap between ambulatory and inpatient care can lead to increased transmission and illness severity. Early identification has substantial impacts on timely implementation of IP mitigation strategies, appropriate handoff upon entry into other care settings, and timely reporting to public health organizations. Current IP processes underutilize electronic health record (EHR) capabilities by relying upon lab driven notifications. This project sought to redesign the IP’s workflows, advancing the health system beyond the acute care setting and into the ambulatory care setting by adding the power of diagnosis codes to close a practice gap. Method: Infection Prevention and Information Technology collaborated to build silent best practice advisories (BPAs) in the EHR that utilized diagnosis codes related to Varicella zoster (VZV) infection charted by ambulatory care providers. These BPAs function by triggering infection statuses that populate the patient chart and include instructions to front line staff on personal protective equipment (PPE) requirements. These BPAs also trigger real-time notifications to the IP team to determine the validity of the infection status and exposure work-up necessity. Chart reviews of diagnosis codes utilized in pre and post intervention timeframes were completed to understand the impact of the silent BPAs. Percentages of patients captured, and Healthcare Worker (HCW) exposure reviews reported were evaluated to demonstrate effectiveness. Plan, Do, Study, Act (PDSA) was utilized to respond to gaps, increase efficiency, and limit erroneous infection statuses. Result: The one-year pre-intervention period revealed 36 total diagnosis codes used for Varicella zoster (VZV) infection; 3% of these infection cases were captured and 4% of eligible cases were reported for HCW exposure review. The one-year post intervention period revealed 40 total diagnosis codes used for VZV infection; 80% of these infection cases were captured and 70% of eligible cases were reported for HCW exposure review. PDSA quality improvement cycles allowed for refinement of the BPA logic that further increased infection cases captured to 100% with 100% of eligible cases reported for HCW exposure review. Conclusion: Utilizing the EHR, the organization appreciated enhanced identification of patients in real-time with VZV infection that allowed for appropriate mitigation strategies to be implemented. This proactive workflow design helps minimize the risk of transmission between ambulatory and acute settings and facilitated HCW exposure reviews.

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.

Assessment of the Seroprevalence of Varicella zoster Virus in Young Adults Aged 15 – 35 Years Old in Mashhad, Iran

Background: Varicella zoster virus (VZV) is highly contagious and can lead to two distinct diseases. Initially, it causes chickenpox, a primary infection common among children worldwide, characterized by itchy, red blisters that cover the body. After this initial outbreak, the virus can lie dormant in nerve tissues and may reactivate later in life as herpes zoster, commonly known as shingles, which presents as a painful rash. While chickenpox is generally mild and resolves on its own, it can cause severe complications, especially in vulnerable groups such as immunocompromised individuals or adults. These complications can range from bacterial superinfections and pneumonia to encephalitis. In rare cases, it may lead to life-threatening conditions like necrotizing fasciitis or toxic shock syndrome, highlighting the potential severity of what is often considered a childhood illness. Objectives: One of the main risk factors for varicella-zoster infection is the absence of immunity. Individuals who have not been vaccinated against or previously infected with the VZV are at risk of contracting chickenpox when exposed. Additionally, close contact with infected individuals increases the likelihood of transmission. People with chronic conditions or those undergoing immunosuppressive therapy are particularly vulnerable to severe complications from varicella-zoster infections. Therefore, this study was conducted to assess the seroepidemiology of antibodies against varicella zoster in the young adult population in Mashhad. Methods: This cross-sectional study was conducted in 2018 on men and women aged 15 to 35 years in Mashhad, northeast Iran. Random cluster sampling was utilized. Individuals undergoing treatment for rare diseases were excluded from the study. The enzyme-linked immunoassay (ELISA) technique was employed to assess the presence of IgG antibodies against varicella zoster in 724 serum samples. Data analysis was performed using SPSS 20, and the significance level was set at 0.05. Results: Overall, among the 724 participants aged 15 - 35 years old in Mashhad, the frequency of anti-varicella IgG seropositivity was 85.9%. Our results indicated significant associations between age (P = 0.001) and occupational status (P = 0.02) with varicella-zoster seroprevalence. Conclusions: We observed a high frequency of anti-varicella zoster IgG seroprevalence among young adults in Mashhad. Infants, pregnant women, and individuals with weakened immune systems are more likely to develop severe forms of chickenpox or experience complications from shingles, including pneumonia and encephalitis. Given the severe health problems caused by the varicella virus and its high prevalence in Mashhad, we recommend incorporating the varicella vaccine into the public vaccination program. Additionally, further examination of the burden of herpes zoster, including its impact on quality of life and healthcare utilization, can guide interventions to mitigate the consequences of this condition.

Varicella in the 21st Century.

Varicella is a highly contagious disease caused by the varicella-zoster virus and has a wide range of clinical presentations. Varicella can cause mild disease in infants born to infected persons who are immunized as a result of previous vaccination or previous clinical or subclinical infection. However, varicella can also lead to severe life-threatening disease in infants, particularly for those born to nonimmunized persons. In this review, we will summarize the natural history of varicella-zoster infection in pregnant persons, infants with congenital varicella syndrome, and infants with postnatal varicella infection. We will also provide guidance about isolation recommendations and chemoprophylaxis for exposed hospitalized infants. Finally, we will describe risk factors for developing disseminated disease and review the approach to treatment of infected infants.

The Role of Tecovirimat in the Management of Monkeypox

Monkeypox is a self-limited disease with symptoms that disappear within 14 to 21 days. Clinical management of monkeypox includes general supportive care and the use of antivirals that have activity against the monkeypox virus. This literature study aims to describe the role of tecovirimat in the management of monkeypox. Tecovirimat is an antiviral drug approved by the U.S. Food and Drug Administration (FDA) as part of the treatment management of smallpox in adults and children. Evidence of the efficacy of tecovirimat as mpox therapy was obtained from animal studies, where tecovirimat reduced mortality rates, reduced duration of illness and viral shedding. Tecovirimat inhibits the vp37 viral protein encoded by the F13 gene of the variola virus. This protein is highly conserved in orthopoxviruses, allowing tecovirimat to have in vitro activity against several orthopoxviruses, including vaccinia, variola, cowpox, and monkeypox viruses. In conclusion, tecovirimat is used in monkeypox sufferers with severe clinical conditions (sepsis, encephalitis, extensive lesions, bleeding manifestations), patients at risk of experiencing severe clinical conditions (immunocompromised, pregnant or breastfeeding, history of psoriasis, varicella zoster infection) and patients with one or more complications.

Pediatric Peripheral Facial Palsy Following Varicella Zoster Infection.

Peripheral facial palsy, characterized by sudden weakness or paralysis of the facial muscles, can arise from various etiologies, including viral infections. While Ramsay Hunt syndrome is well-established in clinical practice, Varicella Zoster Virus (VZV) infection leading to facial nerve palsy in pediatric patients remains relatively uncommon.This comprehensive case report documents the clinical presentation, diagnostic evaluation, treatment, and outcomes of a 10-year-old boy who developed left peripheral facial palsy following a primary Varicella infection. The report underscores the importance of timely recognition and tailored management approaches in achieving a complete remission of symptoms in pediatric patients.

Herpes zoster infection in pregnancy: features and consequences.

Herpes (varicella) zoster (HZ) infection occurs in 4 people per 1000 in the general US population (irrespective of prior varicella infection and vaccination status) each year and has been the subject of scientific inquiry for decades. The consequences of infection are myriad and may depend on the dermatome of involvement as well as host factors such as age, comorbidities, prior treatment or immunization, and immunologic status. Pregnancy is associated with an altered immune and hormonal status in the mother. While maternal HZ infection during pregnancy is not uncommon, the implications for both mother and child are not well established, although multiple studies of perinatal maternal HZ infection suggest no intrauterine transmission to the fetus. We review the current literature on herpes zoster infection in pregnancy, including epidemiology, diagnosis, potential immunologic sequelae, and strategies for prevention and treatment.

Ramsay Hunt Syndrome with Numerous Cranial Nerve Damage Revealing An HIV Infection: A Case Report

Ramsay-Hunt syndrome corresponds to a Varicella zoster infection recurrence in the facial nerve’s sensory ganglion cells in patients with primary varicella infection. It manifests by coetaneous lesions of the sensitive Ramsay-Hunt zone, peripheral facial paralysis, and audiovestibular signs. The prognosis is usually good with well-conducted anti-viral treatment. We report the case of a 49-year-old lady who presented with several cranial nerve injuries, including impairment to cranial nerves V, VII, VIII, IX, and X, along with left facial paralysis, vesicles, discomfort in the left ear, dysphagia, and dysphonia. Her work-up in the search for an immune deficiency objected to an HIV infection. This case study aims to raise awareness among doctors to evaluate Ramsay Hunt syndrome in a patient with HIV who presents ear discomfort and insists on a diversified approach to patient care.

Varicella zoster virus outbreak in a long-term care unit of a tertiary care hospital in northern India.

Nosocomial outbreak of varicella zoster virus (VZV) has been reported when susceptible individuals encounter a case of chicken pox or shingles. A suspected VZV outbreak was investigated in a 50-bedded in-patient facility of Physical Medicine and Rehabilitation in a tertiary care multispecialty hospital. A 30-year-old female patient admitted with Pott's spine was clinically diagnosed with chicken pox on 31 December 2022. The following week, four more cases were identified in the same ward. All cases were diagnosed as laboratory-confirmed varicella zoster infection by PCR. Primary case was a housekeeping staff who was clinically diagnosed with chicken pox 3weeks prior (9 December 2022). He returned to work on eighth day of infection (17 December 2022) after apparent clinical recovery but before the lesions had crusted over. Thirty-one HCWs were identified as contacts a and three had no evidence of immunity. Two of these susceptible HCWs had onset of chickenpox shortly after first dose of VZV vaccination was inoculated. All cases recovered after treatment with no reported complications. VZV infection is highly contagious in healthcare settings with susceptible populations. Prompt identification of cases and implementation of infection prevention and control measures like patient isolation and vaccination are essential for the containment of outbreaks.

Invasive group A streptococcal infections in children and adolescents in Denmark during 2022–23 compared with 2016–17 to 2021–22: a nationwide, multicentre, population-based cohort study

A historic increase in paediatric invasive group A streptococcal (iGAS) infections was reported globally in 2022. iGAS infections can lead to severe manifestations (eg, pleural empyema, necrotising fasciitis, toxic shock syndrome, osteomyelitis, septic arthritis, and meningitis). We aimed to compare the incidence and severity of iGAS infections overall, for distinct clinical phenotypes, and for GAS emm variants in Denmark in 2022-23 with reference to the previous six seasons (ie, 2016-17, 2017-18, 2018-19, 2019-20, 2020-21, and 2021-22). In this nationwide, multicentre, population-based cohort study, we included all children and adolescents in Denmark aged 0-17 years with a positive culture of GAS or GAS confirmed through PCR-based methods from otherwise sterile sites in 2022-23 and the previous six seasons from 2016-17 to 2021-22. For all seven seasons, data were obtained from week 21 to week 20 of the next year. Patients at all 18 paediatric hospital departments in Denmark were identified through the Danish Microbiology Database, in which iGAS isolates from sterile sites are prospectively registered, including emm typing. We obtained electronic medical health records for each patient admitted with a diagnosis of iGAS. We calculated the incidence of iGAS per 1 000 000 inhabitants aged 0-17 years in each season from week 21 to week 20 of the next year and the risk ratios (RRs) for incidence of iGAS, distinct disease manifestations, and emm variants in 2022-23 versus the three pre-COVID-19 seasons in 2016-17, 2017-18, and 2018-19 using Fisher's exact test and Pearson's χ2 test. Among the Danish population of 1 152 000 children and adolescents aged 0-17 years, 174 with iGAS disease were included. 76 children and adolescents with iGAS during 2022-23 were identified; 31 (41%) of 76 were female and 45 (59%) were male. 98 children and adolescents with iGAS during 2016-17 to 2021-22 were identified; 41 (42%) of 98 were female and 57 (58%) were male. There was an increase in incidence of iGAS from mean 22·6 (95% CI 14·7-33·1) per 1 000 000 children and adolescents during 2016-17 to 2018-19 to 66·0 (52·0-82·6) per 1 000 000 during 2023-23 (RR 2·9, 95% CI 1·9-4·6; p<0·0001). During the COVID-19 pandemic in 2019-20, 2020-21, and 2021-22, the mean incidence of iGAS was 6·1 (95% CI 2·4-12·5) per 1 000 000 children and adolescents. In 2022-23, there was a 9·5-fold increase in emm-12 (95% CI 2·2-40·8; p=0·0002) and a 2·7-fold increase in emm-1 (1·3-5·5; p=0·0037). The most common clinical manifestations of iGAS in 2022-23 were soft-tissue infections, which increased by 4·5-fold (1·9-10·9; p=0·0003), and complicated pneumonia with parapneumonic effusion, which increased by 4·0-fold (1·4-11·4; p=0·0059), both compared with the three pre-COVID-19 seasons. Overall, there was no increased severity of iGAS in 2022-23 compared with the previous six seasons as measured by median duration of hospital stay (8 days, IQR 4-14 vs 9 days, 5-15; p=0·39), paediatric intensive care unit (PICU) admission (17 [22%] of 76 vs 17 [17%] of 98; p=0·53), duration of stay in PICU (4 days, IQR 2-10 vs 4 days, 2-11; p=0·84), or mortality (three [4%] of 76 vs three [3%] of 98; p=1·00). In 2022-23, there was a 3·6-fold (95% CI 1·8-7·3; p=0·0001) increase in children with a preceding upper respiratory tract infection and a 4·6-fold (1·5-14·1; p=0·0034) increase in children with a preceding varicella-zoster infection, both compared with the three pre-COVID-19 seasons. In Denmark, the incidence of paediatric iGAS increased in 2022-23 compared with the three pre-COVID-19 seasons of 2016-17, 2017-18, and 2018-19. However, the course of iGAS disease in children and adolescents in 2022-23 was not more severe than in previous seasons. The high morbidity across all seasons highlights iGAS as a major invasive bacterial infection in children and adolescents. Innovation Fund Denmark.

Unveiling the Connection: A Case Report on GBS Following Varicella Zoster Infection

Unveiling the Connection: A Case Report on GBS Following Varicella Zoster Infection

CD3xCD20 Bispecific Antibodies Yields Long-Term Survival in Relapsed/Refractory B Cell Lymphoma: A Follow-up Study of Patients Treated in Pivotal Phase 1/2 Trials

Introduction: T-cell engaging CD3xCD20 bispecific antibodies like glofitamab, mosunetuzumab and epcoritamab are a new group of immunotherapies with promising results in B-cell lymphomas. T-cell engaging antibodies might have milder adverse effect profile compared to chimeric antigen receptor T-cell therapy (CAR-T). However, the duration of response to these new agents is still uncertain and follow-up times for glofitamab and epcoritamab have been short. We performed extensive follow-up of all patients in Denmark who received CD3xCD20 bispecific antibodies in early pivotal phase 1 / 2 trials to map the response, adverse effects and long-term survival, and baseline correlates with these outcomes. Methods: Patients who received T-cell engaging CD3xCD20 bispecific antibodies from 2017 to 2023 as part of a clinical trial were included. The patients' electronic health records were assessed for sex, age, prior therapy, dose received, stage of disease, response according to Lugano criteria, target lesion response, Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity (ICANS) events, infections leading to hospitalization, event-free and overall survival. Kaplan-Meier estimates were provided for all time-to-event end points. Hazard ratios with two-sided 95% confidence intervals were calculated from a Cox proportional-hazards model. Results: A total of 130 patients with relapsed/refractory B cell lymphoma who received bispecific CD3xCD20 antibodies were analyzed. The median age of patients was 70 years (21 to 87 years) and 58% were male. The median number of prior lines of therapy was 3 and the median Ann Arbor stage was 4. B-symptoms were present in 18% of patients before treatment. The median follow-up time from first treatment was 14.8 months (4 to 74 months). Best overall response rate in all patients was 75% (95% CI, 67-83); 54 patients (45%) had complete response (CR), and 37 patients (31%) had partial response (PR). Among patients with a complete response (CR), the median duration of response was 22.5 months and 29.4 months in patients with DLBCL and follicular lymphoma, respectively. Among all patients, the most common adverse effects included CRS (max. grade 1 n=45, max. grade 2 n=28, max. grade 3 n=3 max. grade 4-5 n=0), Varicella Zoster infections (n=8), hypogammaglobulinemia (n=14), therapy-related leukemia (n=3) and autoimmune colitis or hepatitis (n=5). Two patients were diagnosed with ICANS, both grade 1. A total of 54 patients were hospitalized due to infections either during or after treatment. The most common infectious agents that lead to hospitalization were Sars-Cov2 (n=20) and Varicella zoster (n=8). Among patients who received the recommended phase two dose (R2PD) the incidence of CRS was 63% while patients who received doses lower than R2PD had an incidence of 53%. At 12 months after the first treatment, the rate of overall survival (OS) was estimated to 65% in all patients (95% CI, 57-74). (Figure 1), while it was 67% (95% CI, 56-68) in patients who received the recommended phase 2 dose (R2PD). The 24-month overall survival of all patients was estimated at 55 % (95% CI, 45-64), while the 24-month overall survival for patients who had received R2PD was 58% (95% CI, 45-70). The 24-month event free survival of all patients was estimated at 42% (95% CI, 33-51), while the 24-month event free survival for patients who had received the recommended phase 2 dose was 50% (95% CI, 39-62) Five patients died of disease progression within 30 days after first treatment. No deaths were attributed to bispecific antibodies or CRS. Among patients with a complete response (CR) the rate of PFS at 12 months was 84% (95% CI, 75-95). Of the patients who achieved complete remission, 73% (95% CI, 59-87) were still in complete remission after 36 months (Figure 1). Conclusions: We here present long-term national follow-up of heavily pre-treated patients who have received glofitamab or epcoritamab as part of early pivotal phase 1 / 2 trials. We found an overall response rate of 75% in all patients with 45% achieving complete remission. Most common adverse events were CRS and hypogammaglobulinemia, with the incidence of ICANS being notably low. Additionally, we found that CD3xCD20 bispecific antibodies can induce durable long-term responses with 73% of those who achieve complete remission still being in remission after 3 years.

Guillain-Barré syndrome following varicella-zoster virus infection: a case report and systematic review.

Guillain-Barré syndrome (GBS) is an acute inflammatory disease of the peripheral nervous system, rarely following Varicella-zoster virus (VZV) infection. The authors aimed to review all cases in the English literature of GBS that occurred after primary VZV infection to investigate the clinical features, diagnostic workup, treatment, and outcome of patients with GBS following VZV. PubMed, Scopus, and Embase are systematically searched from their inception to 9 May 2022 to collect all cases of GBS following varicella-zoster infection. Patients with GBS following VZV reactivation were excluded. Among the 29 patients, the age of presentation ranged from 1.5 to 70 years with a median of 37, with a yield for males (81.5%). Most of the patients presented with sensory-motor symptoms (65.4%) and suffered from tetraparesis (81.5%). Cranial nerve palsy was present in (84%) of patients, and the seventh cranial nerve was the most commonly affected nerve (75%). Lumbar puncture showed albuminocytological dissociation in (80%) of patients. The dominant nerve conduction study subtype was acute inflammatory demyelinating polyneuropathy (65.3%). in addition, the magnetic resonance imaging showed pathological findings in only (47.5%) of the patients. Intravenous immunoglobulin is now the drug of choice for all cases of GBS following VZV infection. GBS is a rare neurological complication of primary infection with VZV. However, the authors should suspect this syndrome when a patient develops ascending weakness, regardless of the absence of areflexia and albuminocytological dissociation. Drug therapy with IIVIg ensures a gradual improvement for the patient over a period of weeks to several months.

Varisela Neonatal

Varicella or chickenpox is a highly contagious infectious disease. Transmission of varicella-zoster infections in neonates can occur through transplacental (congenital), or postnatal (acquired) route. Diagnosis of neonatal varicella is based on contact history and clinical presentation. Neonatal varicella had risk for severe disease and high mortality rate.

Generalized Varicella Zoster infection in a patient with lymphogranulomatosis after bone marrow transplantation: clinical and laboratory characteristics and virus genotyping

A description of a laboratory confirmed clinical case of generalized Varicella Zoster infection in a patient with lymphogranulomatosis after bone marrow transplantation is presented.Detection of the Varicella Zoster virus in biological material was carried out by real-time PCR using the RealBest DNA VZV test system manufactured by Vector-BEST, Russian Federation. Isolation of viral DNA from biological material was performed using the ArtRNA MiniSpin kit (ArtBioTech, Belarus) or QIAamp DNA mini kit (QIAGEN, Germany).The disease had an atypically severe course with a multiorgan lesion, represented not only by lesions of the skin and mucous membranes, but also by the development of encephalitis, myocarditis, and pneumonia. The disease was characterized by an acute onset, with a pronounced intoxication syndrome, signs of pancreatitis with the appearance of a widespread vesicular rash on the trunk and extremities, prone to fusion, located, including on the scalp, on the feet and palms. The disease was complicated by a secondary bacterial infection, in connection with which the patient received both antiviral treatment and broad-spectrum antibiotic therapy.The virus was assigned to clade 3 (or E2 genotype according to the old classification), the same genotype as the viruses circulating in Minsk. This case is the first described case of generalized VZV infection in the Republic of Belarus, confirmed by laboratory using molecular genetic methods.

Herpes Zoster Infections in Solid-Organ Transplant Recipients.

Herpes zoster infections can be complicated and mortal in solid-organ transplant recipients. In our study, we investigated herpes zoster infections in solid-organ transplant recipients. UntilJune 2022, our center has performed 3342 kidney, 708 liver, and 148 heart transplants.Herpes zosterinfections were investigated in 1050 adult solid-organ transplant recipients from January 1, 2011, to June 31, 2022. We studied 44 patients diagnosed with herpes zoster infections. Of the 44 patients with herpes zoster, 32 had kidney, 7 had heart, and 5 had liver transplant procedures. Crude incidence rate was 5.2%.,with 9.7% being heart, 5.1% being kidney, and 3.9% being liver transplant recipients; 72.7% were male patients. The median age was 47.5 years, and 61% of patients were aged >45 years. Postherpetic neuralgia was significantly higher in patients older than 45 years (P = .006). The median duration to infection posttransplant was 16.5 months. The dermatomes of patients were 43.2% thoracic. Sacral dermatome involvement was significantly higher in heart transplant patients than in other transplant recipients (P = .015). We reviewed specific findings of the Tzanck test in 36.4% of the patients. There was concomitant infection in 15.9% of the patients, and 6.8% had pneumonia. Acute neuritis was more common in kidney transplant recipients (65.6%). The mean duration of acute neuritis/neuralgia was longest in liver transplant recipients (13.5 months; P = .047). Postherpetic neuralgia was detected as high as 24%. Early specific and supportive treatmentis important for transplant recipients with herpes zoster infections. Appropriate antiviral prophylaxis regimens and vaccination strategies for varicella zoster (chickenpox) and herpes zoster infections should be implemented in the vaccination schedule of solidorgan transplant candidates to prevent herpes zoster infections and complications.