Vesicular Skin Lesions Research Articles

Management of Herpes Zooster (Kaksha) through Ayurveda: A Case Study

Background: Varicella zoster virus is the virus that causes shingles or Herpes zoster. Vesicular eruption within the dermatome that occurs unilaterally and is intensely painful. Pre-eruptive, acute exudative, and chronic are the three stages of the disease manifestation. Herpes zoster clinical manifestation includes vesiculo-pustular eruptions accompanied by excruciating pain and burning sensation, which is comparable to the symptomatology described in Ayurveda while referring to the disease kaksha mentioned in kshudra roga. Analyzing symptomatology reveals that, vitiatiation of pitta due to indulging in various causative factors affects Twak and Rakta Dhatu thereby causing this illness. Consequently, pitta shamana line of therapy is advised which helps in samprapti vighatana and dosha shamana. Materials and Methods: A 38-year-old woman’s vesicular skin lesion across her right axilla, arm, and palmar aspect of her left ring finger, along with intense pain, and burning sensation associated with blackish discoloration surrounded by inflammatory signs such as rubor, calor, dolor were her primary complaints. In this case pitta-hara line of management was employed as mentioned in the management of disease Kaksha. Observation and Result: Lesions started to shrink and fall off without any indications of further spread or reoccurrence. Falling lesions had slight yellow discharge from the sight but pain and discomforts had disappeared.

Creating the "Dew Drop on a Rose Petal": the Molecular Pathogenesis of Varicella-Zoster Virus Skin Lesions.

Varicella-zoster virus (VZV) is a human alphaherpesvirus that causes varicella (chicken pox) as the primary infection in a susceptible host. Varicella is very contagious through its transmission by direct contact with vesicular skin lesions that contain high titers of infectious virus and respiratory droplets. While the clinical manifestations of primary VZV infection are well recognized, defining the molecular mechanisms that drive VZV pathogenesis in the naive host before adaptive antiviral immunity is induced has been a challenge due to species specificity. This review focuses on advances made in identifying the differentiated human host cells targeted by VZV to cause varicella, the processes involved in viral takeover of these heterogenous cell types, and the host cell countermeasures that typically culminate in a benign illness. This work has revealed many unexpected and multifaceted mechanisms used by VZV to achieve its high prevalence and persistence in the human population.

373. Development of multiplex loop-mediated isothermal amplification (LAMP) based on a microfluidic chip for detection of HSV-1 and 2 and VZV.

Abstract Background In the era of universal varicella vaccination, point-of-care testing for herpes simplex viruses 1 and 2 (HSV-1, HSV-2) and varicella-zoster virus (VZV) is becoming more important because of the increase in the number of breakthrough varicella cases. The Loop-mediated isothermal amplification (LAMP) method is a reliable method for rapid diagnostic tests for infectious diseases. Meanwhile, microfluidics technology is revolutionary in total system miniaturization, including facile parallelization through multiplexing and process-reduced reagent volumes. It is easy to create miniaturized chips containing multiple chambers according to the needs. In this study, we sought to develop multiplex LAMP for the detection of HSV-1, HSV-2, and VZV DNA using in-house microfluidic chips. Methods The polydimethylsiloxane-based chip consists of microfluidic channels and 5 reaction chambers. The specific primers were pre-spotted and dried in each chamber. The condition of LAMPs and each specific primer were described previously. The sensitivity of microfluidic LAMPs was confirmed using plasmids that contain the target sequences. In order to assess the reliability of clinical use, 35 swab samples (without DNA extraction) collected from patients with vesicular skin lesions were used. The result of microfluidic multiplex LAMP was compared with conventional LAMPs and real-time PCRs. Results Detection limits of HSV-1 and 2 and VZV LAMP-based on a microfluidic chip were 500 copies per reaction. Among 35 swab samples, HSV-1, HSV-2, and VZV DNA were detected in 10 (28.6%), 4 (11.4%), and 12 (34.3%) samples, respectively. The results of microfluidic LAMPs were completely consistent with the results of conventional LAMPs. HSV-1 DNA was detected in one LAMP negative sample by real-time PCR. One HSV-1 LAMP positive sample was negative in real-time PCR. If real-time PCR was used as a standard, sensitivity of HSV-1, HSV-2, and VZV LAMPs based on microfluidic chip were 90%, 100%, and 100%, and the specificity of three methods were 96%, 100% and 100%, respectively. Conclusion Multiplex LAMP, based on a microfluidic chip that detects three alpha herpesviruses, may be useful in laboratory diagnosis of patients with vesicular skin lesions. Disclosures All Authors: No reported disclosures.

A HIV-positive subject with dermatomal and generalized vesicular skin lesions

A 58-year old man with HIV infection diagnosed in 2018 presented in July 2021 with a 7-day history of vesicular skin lesions localized to the right side of abdomen and diffuse vesicular lesions on the face, trunk, abdomen and both arms (Fig. 1A e 1B).

Viral exanthem following influenza vaccine

Abstract Introduction: Influenza vaccination (flu vaccine) is associated with some musculoskeletal and neurological complications despite its wide use and significant safety profile. Skin is one of the most common systems for drug reactions and side effects. Skin rashes such as bullous eruptions and vasculitis have been reported, but viral exanthem are seldom reported in association with the influenza vaccine. In particular, herpes simplex virus-2 reactivation and myelitis following influenza vaccination manifesting as severe herpes simplex virus type 2 and associated with blisters on the back of a single patient have been reported before. However, data on the rate of such complications are scarce in the literature. Patient concerns: A young woman complained of an unusual presentation of eruptive vesicular skin lesions following influenza vaccination complicated by allergic contact dermatitis to lemon soap applied to the lesions. Diagnosis: Viral exanthem were diagnosed based on clinical presentation and supported by a skin biopsy. Interventions: Medical treatment with antiviral and corticosteroids. Outcomes: The patient had a favorable outcome. Conclusion: Dermatologists should be vigilant to the association with any new medications and skin lesions, observe the progression of the lesions, and revisit the medical history to establish the correct relationships for any possible new causative agent to an evolving or new developing lesion.

Onychomadesis- A Late Manifestation of Hand, Foot and Mouth Disease: A Case Series

Hand Foot Mouth Disease (HFMD) is one of the most common viral illness that is characterised by fever below 38.3°C, painful oral lesions on the tongue and buccal mucosa and macular, maculopapular or vesicular skin lesions on the soles and palms. Many viruses are implicated in HFMD, such as Coxsackievirus A5, A6, A7, A9, A10, A16 (most common), B1, B2, B3, B5, Echoviruses E3, E4, E9 and Enterovirus 71. The illness is usually mild and self-limiting. HFMD due to Enterovirus 71, is associated with a severe illness complicated by aseptic meningitis, acute flaccid paralysis, pulmonary oedema and heart failure. Onychomadesis is a very rare complication of HFMD, typically occurring three to eight week of onset of illness. This is characterised by the detachment of the nail plate from the proximal nail fold by a full thickness sulcus. It is postulated that viral infection causes inflammation around the nail matrix either due to direct effect or due to the deposition of immune complexes secondary to distal thromboembolism. Here, authors report six children of different age groups who were affected with onychomadesis during an outbreak of HFMD in the month of February to May 2022 in Chennai, Tamil Nadu, India. All these six children developed onychomadesis following HFMD, after a couple of weeks. Both upper and lower limb nails were involved. Other causes of onychomadesis like chronic illness, nutritional deficiencies, drug ingestion, periungual dermatitis, trauma were ruled out. Children were given supportive care and were followed-up. The changes in nails spontaneously regressed after a couple of weeks.

Herpes-zoster-Update – was gibt es Neues?

AbstractShingles are triggered by the reactivation of an infection with the varicella zoster virus (VZV) and are characterized by specific vesicular skin lesions. Mostly, elderly patients are affected. Depending on the affected dermatome, some serious complications can be observed. The introduction of a vaccine against shingles in Germany offers a great potential for reducing the frequency and severity of this disease. There are both a live vaccine, which is no longer recommended, and an inactivated vaccine, which, however, is still not sufficiently recommended to the authorized patient groups and is also only available to a limited extent due to delivery bottlenecks. HZ neuralgia is a serious complication of the disease that requires rapid and effective therapy and should be handed over to experienced pain therapists rather too early than too late. Unfortunately, in everyday clinical practice only a few people are familiar with VZV vasculopathy, which is associated with a significantly increased risk of cerebral insults.

Congenital candidiasis – a diagnostic challenge

Introduction: Congenital candidiasis is a rare intrauterine infection characterized by vesicular and pustular skin lesions appearing in the first six days of life. Clinical case: The authors describe the case of a full-term infant presenting erythematous macules, vesicles and pustules involving the trunk and extremities and cervical burn-like dermatitis at birth. Mycological skin lesion culture was positive for Candida albicans. Blood culture was positive for methicillin-sensitive Staphylococcus aureus. After systemic antifungal and antibiotic therapy was started, the newborn remained asymptomatic with lesion improvement. Discussion/ Conclusion: Herein is reported a case of congenital candidiasis in a full-term infant, with a successful recovery. The rarity of congenital candidiasis can lead to delayed diagnosis and unnecessary treatment. This case shows that fungal infection should be considered in the differential diagnosis of vesiculopustular skin lesions in neonates. Systemic therapy should be initiated if invasive candidiasis is suspected.

S2719 A Rare Case of Disseminated Varicella Zoster in a Young Patient With Cirrhosis

INTRODUCTION: Herpes zoster, otherwise known as shingles, occurs after reactivation of the dormant, neurotropic, varicella zoster virus (VZV) that lies in the dorsal root ganglia. The typical manifestation consists of self-limiting, painful, vesicular skin lesions that follow a dermatomal pattern. Herpes zoster can present as a disseminated infection in immunocompromised patients (e.g., HIV, malignancy, chronic immunosuppressive drugs) and, very rarely, in immunocompetent individuals. Patients with cirrhosis are deemed to be at high risk for infections as a result of immune dysfunction although a nationwide, population-based study from Taiwan has shown that cirrhosis is not associated with an increased risk for herpes zoster. Furthermore, although there are case reports of post-vaccine primary varicella infection and subsequent dissemination, there appear to be none detailing a dissemination of reactivated varicella zoster in a cirrhotic patient. CASE DESCRIPTION/METHODS: We present a case of a 34 yr old male on no medications, with a twelve year history of heavy alcohol use and decompensated cirrhosis, who was admitted for higher level of care and liver transplant evaluation. Ten days into his admission, vesicular lesions were noted on his left flank. VZV PCR testing showed 438,342 copies/mL. Workup for other infections such as Hepatitis A, B, C and HIV were negative. The patient was initially started on 350 mg IV acyclovir every twelve hours which was subsequently increased to 700 mg IV due to presence of VZV in the ascitic fluid that was concerning for dissemination. Unfortunately, the patient developed multi-organ system failure and passed away. DISCUSSION: This case highlights a rare instance of VZV dissemination in a young patient with cirrhosis who only displayed a cluster of vesicles on his left flank. While VZV dissemination has been known to occur in immunocompromised patients, cirrhotic patients have not usually been considered to be at higher risk for reactivation or dissemination. Our case highlights the importance of early diagnosis and prompt, aggressive management of shingles in patients with cirrhosis to reduce the risk of disseminated VZV and mortality.

A novel poxvirus isolated from an Egyptian fruit bat in Israel.

An Egyptian fruit bat (Rousettus aegyptiacus) from the Zoological Gardens, at Tel Aviv, Israel, showed pox‐like clinical signs including vesicular and nodular skin lesions on the wings. Cell culture isolation, histopathology, electron microscopy and molecular analysis, revealed the presence of a novel bat poxvirus. Future research is needed to determine whether this virus can affect human health.

English

English

Maternal Death due to Viral Sepsis

Sepsis accounts for approximately 10% of all maternal deaths and in pregnancy, as a result of cell-mediated immunity is altered and prone for infection. Varicella zoster virus (VZV) commonly causes chickenpox in children and herpes zoster in adults. In this case, viral sepsis probably due to VZV has caused a death of an apparently immune-competent young mother. A 19-year-old unmarried sex worker with Grave’s disease presented in her second trimester with ankle oedema and shortness of breath. She was hypertensive and anaemic and was treated for secondary hypertension due to thyrotoxicosis. Later, she developed fever, oliguria and heart failure. She was treated in intensive care unit with hyperthyroid crisis induced by sepsis due to pneumonia. She developed high fever, intra-uterine death, hepato-renal failure, disseminated intravascular coagulation (DIC) and died on day fourteen. At autopsy, dermotomal vesicular skin lesions and vulval viral warts were seen. The internal organs showed sepsis. Blood for HIV was negative. Histopathology revealed viral pneumonia, myocarditis and DIC. Cause of death was given as sepsis due to viral pneumonia probably following VZV. The clinical diagnosis was septicaemia, due to pneumonia, but herpes zoster infection was not diagnosed. VZV infection can be life threatening even in immune-competent adults. The diagnosis of multi-organ failure from VZV should always be clinically suspected in the presence of atypical skin lesions and a temporarily immune-compromised state such as pregnancy.

The Diagnostic Value of Tzanck Test in Vesiculobullous, Pustular, and Oral Lesions in The Dermatology Clinic

Background: Vesiculobullous disorders represent a heterogeneous group of dermatoses with protean manifestations. The accurate diagnosis of bullous disorders of the skin and mucous membrane requires evaluation of clinical, histological, and immunofluorescence findings. Objective: The aim of this study was to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin and oral lesions. Patients and Methods: This cross sectional study was conducted on one hundred patients presented with vesicular, bullous, and pustular skin lesions and/or oral lesions. All patients were included from Dermatology Outpatient Clinic at Al-Zahraa University Hospital over the period from March 2018 to March 2019. Results: Positivity of multinucleated giant cells in herpetic infection, acantholytic cells in pemphigus, dyskeratotic acantholytic cells and cocci in bullous impetigo were useful landmarks in Tzanck smear. A decrease in viral shedding from herpetic lesions of longer duration may correlate with the lower sensitivity of the Tzanck smear. Therefore, in this study we excluded the lesions older than 3 days. The percentage of positivity in vesicles was much higher than that of pustules. Conclusion: According to this study, Tzanck smear was an inexpensive, simple, and rapid test and did not require any specialized laboratory equipment for evaluation of various vesiculobullous and pustular lesions either skin or mucosal one.

Acquired vulvar lymphangioma: Report of two cases

Vulvar lymphangioma is a rare case and often being misdiagnosed as genital wart. This acquired disorder manifests as dilatation of superficial lymph vessel due to obstruction. It is caused by urogenital infection and most often occurs following surgery and radiotherapy of cervical cancer. The diagnosis is established based on clinical and histopathological features. Treatment aimed to eliminate the cause of obstruction. This article reports two cases of vulvar lymphangioma found in our Hospital. First case was a 43-year-old female with a history of surgery and radiation for cervical cancer 10 years ago presented with vesicular skin lesion in genital area, oozing copious clear fluid since 4 years ago. There are multiple lenticular vesicles containing clear fluid in vulvar area accompanied with bilateral lymphedema of lower extremities. Histopathological features demonstrated dilated superficial lymph vessels. Second case was a 44-year-old female with enlargement of lower abdomen with vesicular lesion containing clear fluid in genital area since 3 years ago. Abdominal USG showed enlarged inguinal lymph node. Histopathological features demonstrated dilated superficial lymph vessels. The treatment for both cases were gradual electrosurgery. In both cases, vulvar dermis’ superficial lymph node dilatation caused the skin lesions. Obstruction of lymph vessel due to radiation and surgery for cervical cancer in the first case and of inguinal lymph node in the second case lead to increased lymphatic pressure in the dermis and later on the dilatations. The treatment in both cases using electrical excision produced good responses; however, we should be attentive on recurrent case. Keywords: acquired vulvar lymphangioma, dilatation of dermal lymph vessels, electrosurgery

A Case of Drug-induced Cutaneous Toxicity Observed in Cynomolgus Monkeys.

The purpose of this article is to describe a case of drug-induced cutaneous toxicity observed in cynomolgus monkeys and to introduce approaches attempted in order to elucidate mechanisms. The test article was a small molecule with a ubiquitously distributed target, especially in rapidly dividing cells, and which modulated cell cycle regulation. After 7 consecutive days of oral dosing, animals developed multifocal skin lesions. The lesions were characterized clinically by vesicles and scabs formation and were distributed mainly in thin-skinned areas of the body including the cheek, chest, abdomen, and inner limbs. Microscopically, the lesions were confirmed as epidermal vesicle formation and ulceration. Immunohistochemical staining revealed that the levels within the epidermis where separation (vesicle formation) occurred were not consistent. The differential diagnoses for vesicular skin lesions and our efforts to elucidate the mechanism of toxicity using in-house database searches and immunohistochemistry are discussed. To the best of our knowledge, similar cutaneous toxicity has not been reported previously, although there are reports of other types of cutaneous toxicities. Understanding the mechanisms of the toxicity is very important when assessing human relevancy during drug development. Our investigative approach can be utilized when unusual skin toxicities are observed in the future.

Vibrio tapetis isolated from Vesicular Skin Lesions in Dover Sole (Solea solea)

Vibrio tapetis is primarily known as the causative agent for brown ring disease in bivalves, although it has been isolated from cultivated fish during mortalities on farms. Here we describe the first isolation of V. tapetis from wild-caught and subsequently captive-held Dover sole Solea solea. Pathological features consisted of multifocal circular greyish-white skin discolourations evolving into vesicular lesions and subsequent ulcerations on the pigmented side. On the non-pigmented side, multiple circular lesions-white at the center and red at the edges-were evident. Histological examination of the vesicular lesions revealed dermal fluid-filled spaces, collagen tissue necrosis and a mixed inflammatory infiltrate, with large numbers of small rod-shaped bacteria. In the deep skin lesions, loss of scales and dermal connective tissue, with degeneration and fragmentation of the myofibres bordering the ulceration, were noted. Serotyping, DNA-DNA hybridization and REP- and ERIC-PCR techniques showed that the retrieved isolates displayed a profile similar to the representative strain of genotype/serotype O2 which originally was isolated from carpet-shell clam Venerupis decussata and to which isolates obtained from wedge sole Dicologoglossa cuneata were also closely related.

Unusual Manifestation of Herpes Zoster Infection Involving the Greater, Lesser Occipital and Transverse Cervical Nerve: A Case Report

We here present a case of Varicella Zoster Virus (VZV) infection with involvement of C2 and C3 right cranial nerve. The initial symptoms (right occipital neuralgia, pharyngodynia, and otalgia) were complicated by vesicular skin lesions spread along the course of the right transverse cervical and of greater occipital nerve. The diagnosis was confirmed by serological tests. Therapeutical approach is then commented.

Diagnostic value of Tzanck smear in various erosive, vesicular, and bullous skin lesions.

Background:Cutaneous cytology has long been shown to be useful in the diagnosis of several erosive, vesicular, and bullous skin lesions. The Tzanck smear although an old tool, still remains a simple, rapid, easily applied, and inexpensive test for these skin lesions.Aims and Objectives:The aim of this study was to evaluate the diagnostic value of Tzanck smear by determining its sensitivity and specificity in various erosive, vesicular, and bullous skin lesions.Materials and Methods:One hundred and forty-two patients with erosive, vesicular, and/or bullous skin lesions were included in the study. Four groups of disorders were identified: infections, immunologic disorders, genodermatosis, and spongiotic dermatitis. All the study cases were evaluated by Tzanck smear. Definitive diagnosis was established by standard diagnostic techniques (including when appropriate, viral serology, bacterial culture, histopathology, direct immunoflourescence).Results:The sensitivity and specificity of cytologic findings was respectively 86.36% and 91.30% for viral infections; for bacterial infections, it was 85.7% and 66.6%. The sensitivity and specificity of Tzanck smear was respectively 85.0% and 83.33% for pemphigus; for bullous pemhigoid it was 11.11% and 100.0%. Tzanck smear sensitivity in genodermatoses was 100%. The sensitivity and specificity of the test in spongiotic dermatitis could not be calculated due to an insufficient number of patients.Conclusion:The Tzanck smear is a quick and reliable tool for the evaluation of various erosive and vesiculobullous skin lesions.

Gastro-intestinal Involvement of Primary Varicella Zoster Virus Infection in a Renal Transplant Recipient

Biopsy proven gastro-intestinal involvement of Varicella Zoster Virus (VZV) infection is rare and has not previously been reported in renal transplant recipients. This case report concerns a 65 year old, VZV seronegative, renal transplant recipient who presented with a non-vesicular rash and abdominal pain. Endoscopy revealed gastro-duodenal ulceration and in gastric biopsies VZV-DNA was detected by polymerase chain reaction assay. We conclude that abdominal pain in the absence of vesicular skin lesions may be the presenting symptom of visceral VZV infection, a potentially life threatening disease. To diminish the risk of VZV infection, patients on the waiting list for transplantation who are VZV seronegative or have non-protective VZV-IgG antibody titers, it is advised to vaccinate for VZV prior to transplantation.

Time to Consider Empiric Acyclovir

Purpose: A 63-year-old female presented to the emergency department with a two-day history of fever of 101.9°F and worsening fatigue. She denied a history of liver disease and was otherwise in good health, aside from a history of arthritis. She denied any recent changes in medications, use of antibiotics or travel history. Urine toxicology screen, acetaminophen level and hepatitis A-C serology were negative. Her laboratory assessment was notable for AST 4755 IU/L, ALT 3569 IU/L and an INR of 1.4. She was admitted into her local hospital and started on intravenous N-acetylcysteine. Overnight, she developed subtle changes in behavior without any change in level of consciousness. She was subsequently transferred to a liver transplant center. Upon arrival, the patient was oriented, but very somnolent, and remained febrile at 103.1°F. Physical exam was negative for stigmata of chronic liver disease, rash or asterixis. Laboratory assessment revealed total bilirubin 0.6 mg/dl, AST 7392 IU/L, ALT 5942 IU/L, INR of 2.2, WBC 2900 cells/ mm3, hemoglobin 16 g/dL and platelets of 29,000/mm3. Abdominal ultrasound showed a normalappearing liver with normal hepatic and portal flow. Further history from family revealed the patient was taking oral prednisone the past few weeks for chronic joint pain. Given this history, combined with fever, leukopenia and anicteric hepatitis, she was started on empiric IV acyclovir for possible herpes simplex virus (HSV)-induced liver failure. She underwent expedited liver transplant evaluation. A trans-jugular liver biopsy revealed minimal inflammation with scattered hepatocyptes with glassy nuclear inclusions, azonal areas of necrosis and positive HSV stain. Her serum HSV DNA testing by PCR was 1.2 x 10ˆ6 copies/ml, although her initial HSV IgM was within reference range. Her laboratory values normalized completely within 15 days, and she was discharged to a local rehab center. HSV-induced liver failure accounts for only 1% of all ALF, but confers a mortality rate of 75%. Although immunocompetent patients can be affected, 75% of affected patients are immunosuppressed or pregnant in the third trimester. Patients who present with fever, vesicular skin lesions, leukopenia and anicteric hepatitis need to be considered for empiric acyclovir therapy and transferred to a liver transplant center. Serological testing with antibodies against HSV in the serum is nonspecific and has low utility in early treatment decisions. Confirmation of diagnosis is best performed with liver biopsy and serum HSV PCR. Empiric therapy with acyclovir for patients at risk may obviate the need for liver transplantation.