VZV Infection Research Articles

S4589 Rare Case of Acute Liver Failure Secondary to a Disseminated VZV Infection

S4589 Rare Case of Acute Liver Failure Secondary to a Disseminated VZV Infection

Prognostic factors associated with acute retinal necrosis treated non-surgically.

To analyse the prognostic factors for visual acuity in acute retinal necrosis (ARN) patients treated non-surgically. The clinical data of ARN patients who visited our hospital from January 2010 to January 2023 were retrospectively analysed. Twenty-four patients (29 eyes) were included. Aqueous humour samples were collected from 20 out of 29 eyes, and PCR confirmed that 85% (17/20) of the eyes had VZV infection, 10% (2/20) had CMV infection, and 5% (1/20) had HSV infection. All patients were treated with intravenous antiviral agents. Intravitreal ganciclovir and oral corticosteroids were given according to the patients' wishes. A comparison of visual acuity at the time of first identification of inactive ARN with that at the first visit revealed that 16 (55.2%) eyes improved and 13 (44.8%) did not improve. Logistic regression analysis revealed that risk factors for failure to improve vision after treatment included retinal detachment (odds ratio [OR],33.75; 95% CI, 3.245-351.067; P = 0.003), necrotising retinitis involving the posterior pole (odds ratio [OR],8.167; 95% CI, 1.297-51.403, P = 0.025), and arteritis involving the large retinal arteries (odds ratio [OR],9.167; 95% CI, 1.493-56.297; P = 0.017). The VZV viral load in the aqueous humour at initial presentation was significantly associated with visual prognosis (r = 0.688, P = 0.013), retinal detachment (τ = 0.597, P = 0.021) and the extent of retinal necrosis (τ = 0.57, P = 0.027). The neutrophil to lymphocyte ratio (NLR) of VZV-infected patients at first presentation was significantly correlated with the prognosis of visual acuity (r = 0.616, P = 0.033) and retinal detachment (τ = 0.728, P = 0.004). High NLR and viral DNA copy number in the aqueous humour at the initial presentation, as well as subsequent retinal detachment, necrotising retinitis involving the posterior pole, and arteritis involving the large retinal arteries were risk factors for poor visual prognosis in VZV-infected ARN patients.

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.

Clinical Characteristics and Prognosis of Herpes Zoster Laryngitis With Vocal Fold Immobility

ObjectiveTo investigate the clinical characteristics and prognosis of herpes zoster laryngitis with vocal fold immobility. Study DesignRetrospective study MethodsClinical characteristics, laryngeal signs on strobolaryngoscopy, imaging examination findings, and outcomes of patients were analyzed retrospectively. ResultsThis study included 17 patients (11 males [64.7%] and 6 females [35.3%]), with a mean age of 63.3±6.7 years. The primary symptoms were hoarseness (94.1%), dysphagia (76.5%), pharyngalgia on one side (76.5%), and aspiration (70.6%). No patient had skin herpes of the head and neck. The duration of symptoms was 5–30 days (median: 10 days). Twelve patients (70.6%) were in an immunocompromised state before the disease. Strobolaryngoscopy showed congestion and swelling of the mucosa on one side of the larynx, with whitish eruptions on the supraglottic mucosa and ipsilateral vocal fold immobility. Five patients (29.4%) exhibited signs of ipsilateral accessory nerve injury. The imaging examination showed supraglottic inflammatory changes in 12 patients (70.6%). Among the 14 patients whose treatment could be clearly described, only one patient received antiviral treatment, whereas others received neurotrophic and symptomatic treatment. Notably, all patients demonstrated good outcomes because their symptoms eventually returned to normal. ConclusionHerpes Zoster Laryngitis is caused by VZV infection of the vagus nerve. It is characterized by laryngeal herpetic changes on one side and unilateral vocal fold immobility. The inducement of the disease tends to be associated with the abnormal immune state of patients. It can be easily misdiagnosed because of the absence of skin herpetic changes. Regardless of antiviral therapy, patients generally exhibit a favorable outcome.

Comparison of Infectious Complications in Patients Receiving High-Dose Cyclophosphamide as GvHD Prophylaxis After Transplantation From A 9/10 HLA-Matched Unrelated Donor with Standard GvHD Prophylaxis After Transplant From A Fully Matched Related Donor.

The aim of this study was to evaluate whether cyclophosphamide administered after allogeneic stem cell transplantation (ASCT) from 9/10 HLA-Matched Unrelated Donors (MMUD) increases the rates of bacterial, fungal, viral infections, complications (hemorrhagic cystitis (HC)), and infection-related mortality compared to allogeneic stem cell transplantation from matched related donors (MRD). This is a retrospective multicenter study. 45 MMUD ASCT patients who received posttransplant cyclophosphamide+methotrexate+calcineurin inhibitor compared with 45 MRD ASCT patients who received methotrexate+calcineurin inhibitor. Although there was a statistically significant prolongation of neutrophil engraftment time in the PTCy arm, there was no statistically significant difference in bacterial infection frequencies between the groups (PTCy; 9 (20%), control; 8 (17.8%), p=0.778). The distribution of CMV infection in the first 100 days was similar (p=0.827), but the distribution of CMV infection rate between the 100th and 365th days was observed more frequently in the control group (p=0.005). HC rates and their grades were similar in both groups (PTCy; 4 (8.8%), control; 6 (13.3%) p=0.502). The rates of VZV infection and invasive aspergillosis were similar in the PTCy and control groups (13.3% in the PTCy and 17.8% in the control group p=0.561). There is also no statistically significant difference in survival analysis (OS, LFS, GRFS, RI, IRM, NRM) between groups. However, the incidence of cGVHD was significantly higher in the control group (P=0.035). The addition of PTCy to standard GvHD prophylaxis in MMUD ASCT does not lead to an increase in CMV reactivation, bacterial infections, invasive fungal infection, viral hemorrhagic cystitis, or mortality.

Varicella-Zoster Virus Infections: Epidemiology, Diagnosis and Vaccine Safety

Varicellovirus humanalpha3 (varicella-zoster virus; VZV), a member of the Orthoherpesviridae family, is a human pathogen that is widespread worldwide and has a preventive vaccine that has been used for decades. Primary infection causes chickenpox, in which VZV remains latent in ganglionic neurons after recovery. Primary VZV infection, which is generally associated with mild infections during childhood, can lead to severe and potentially life-threatening complications in newborns, immunocompromised individuals, or the elderly. In individuals whose cellular immunity against VZV decreases with advancing age or in immunocompromised individuals, VZV may reactivate and cause zoster. VZV vaccines, developed from live virus strains weakened by serial passages, have been added to national vaccination programs for the pediatric age group as single or double doses in many countries of the world, and have contributed to a significant decrease in VZV infections and associated complications throughout the world in the post-vaccination period. Apart from pediatric vaccines, live and recombinant herpes zoster vaccines have been developed and approved for use in adults aged 50 and over. Rare complications associated with VZV vaccines, which have been used safely for decades, may also occur. The main focus of this article is VZV vaccines, and in connection with these vaccines, it is aimed to provide an overview of the history, classification, epidemiology, clinic, complications, diagnosis, and treatment of VZV infections.

The Role of Varicella Zoster Virus (VZV) in Central Nervous System Infectious Syndromes

Background: We describe the proportion of VZV infection in central nervous system (CNS) infectious syndromes in a single Israeli medical center.Methods: An observational cohort study was conducted in Kaplan Medical Center (a secondary hospital, Israel) between July 1, 2014, and March 31, 2019. Included were adult patients (≥ 16 years old) with CNS infection with an aseptic CSF profile that were subjected to molecular tests for herpes viruses, HSV either 1 or 2, VZV, enteroviruses, and IgM for West Nile virus (WNV).Results: Clinical presentation suggestive of CNS infection led to lumbar puncture and CSF analysis in 1500 patients yielding 178 cases with aseptic CSF profile. For 62/109 (55.9%) cases of meningitis, the etiology remained unknown, enterovirus accounted for 21 cases (18.9%), VZV for 16 (14.4%), and HSV 1 for 7 (6.3%). One case each of bacterial, fungal, and parainfluenza virus accounted for the other 3 cases. For 30/63 (47.6%) cases of encephalitis, the etiology remained unknown, HSV accounted for 11 cases (17.5%), VZV for 8 (12.7%), and WNV for 10 (15.9%); in two cases, enterovirus was identified and one case of influenza A and one of mycoplasma, accounted for the rest. In six patients with myelitis VZV was identified in 4 (66.7%). Notably, a typical herpetic rash was identified in only 11/28 (39.28%) of cases of VZV CNS infection.Conclusions: VZV is a significant cause of viral CNS infections. In the majority of patients with neurologic syndrome and evident VZV there is no association with a typical herpetic rash. These results apply to Israeli population and likely to other populations with similar background of VZV past infections.

VZV infection causing multiple cranial neuropathies

VZV infection causing multiple cranial neuropathies

EPID-09. ASSOCIATION BETWEEN VIRAL INFECTIONS AND GLIOMA RISK: A TWO-SAMPLE BI-DIRECTIONAL MENDELIAN RANDOMIZATION ANALYSIS

Abstract BACKGROUND Glioma is one of the leading causes of brain tumors, but few etiologic factors of primary gliomas were identified. Previous observational research has shown an association between viral infection and glioma risk. Here, we sought to use Mendelian Randomization (MR) analysis to explore the direction and magnitude of the causal relationship between viral infections and glioma. METHODS We conducted a two-sample bi-directional MR analysis using Genome-Wide Association Study (GWAS) data. Summary statistics data of glioma were collected from the most extensive meta-analysis GWAS involving 12,488 cases and 18,169 controls. Single Nucleotide Polymorphisms (SNPs) associated with the exposures were used as instrumental variables to estimate the causal relationship between glioma and twelve types of viral infections from corresponding GWAS data. In addition, sensitivity analyses were performed. RESULTS After correcting for multiple tests and sensitivity analysis, we detected that genetically predicted VZV infection significantly decreased the risk of lower-grade glioma (LGG) development (OR=0.85, 95% CI: 0.76-0.96, P=0.0066, FDR=0.0396). No causal effects of the other eleven viral infections on glioma and reverse causality were detected. CONCLUSIONS Our research is one of this field's first and most significant studies. We showed robust evidence supporting that genetically predicted VZV infection reduces the risk of LGG. The findings from our research are a big step forward in understanding the etiology of glioma.

Spinal cord stimulator explant caused by post-incisional cellulitis secondary to Varicella Zoster Virus (shingles) infection: a case report

IntroductionSpinal Cord Stimulation (SCS) is a well-established therapy for refractory neuropathic pain, known for its safety and minimally-invasive nature. However, complications, including surgical site infections (SSIs), can arise post-implantation. SCS-related SSIs occur in 3.4% to 4.6% of cases within 90 days post-implant, often requiring device removal and impacting pain management and healthcare costs. The impulse generator, electrode implant site and lumbar/thoracic surgical site are commonly affected, with local skin flora and circulating organisms being the primary causes of infection.Case presentationAn 80-year-old Lebanese male with chronic neuropathic lower back and bilateral leg pain, significantly impairing function, underwent prolonged hospitalizations for COVID-19 infection and acute-on-chronic pain with Urinary Tract Infection (UTI). Considering SCS as a therapeutic option, a successful trial led to permanent implantation, resulting in improved pain severity and functional capacity. However, three months later, the patient developed post-incisional cellulitis and wound dehiscence secondary to Varicella Zoster Virus (shingles) Infection directly over the Implantable Pulse Generator (IPG) incision line. Despite antibiotic treatment, the infection progressed, necessitating SCS system explantation.DiscussionThis represents the first reported case of VZV infection causing wound dehiscence and SCS explantation post-implantation. Contributing factors may include itching around the IPG site, facilitating deeper tissue inoculation. Laboratory and imaging tests may not reliably detect SSIs, and superficial infections may respond to antibiotics, while deep infections typically require implant removal. Early identification and intervention are vital to minimize complications.ConclusionThis unique case emphasizes the need for heightened vigilance and monitoring in patients with viral infections near medical devices. A standardized approach to assessing and managing SCS-related infections is critical. Sharing such experiences contributes to improved understanding and treatment of these rare incidents.

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.

A-298 Performance Analysis of Three Mpox Real Time PCR Kits With Lesion Swab Clinical Samples

Abstract Background The appearance of skin lesions can be a symptom of infection or reactivation of the HSV-1, HSV-2, VZV or T. pallidum or even monkeypox virus infection. Due to the contact-bound ease of spread of these pathogens, an accurate and fast diagnosis, such as PCR-based testing, is key to a good epidemiological management. The aim of this study was to determine the clinical performance of three qPCR assays. Methods A total of 334 cutaneous swabs collected from patients attended at the Hospital Universitario Miguel Servet were analysed using the three assays under study: VIASURE Herpes virus 1, Herpes virus 2 & Varicella Zoster Virus Real Time PCR Detection Kit, VIASURE Treponema pallidum Real Time PCR Detection Kit and VIASURE Mpox Real Time PCR Detection Kit. Samples were collected between December 2021 and November 2022. These samples were requested through the Biobanco del Sistema de Salud de Aragón (BSSA) and have the approval of the Aragón Ethics Committee (PI22/409). DNA/RNA extraction was performed using the automated extraction method magLEAD® 12gC instrument with the MagDEA Dx SV kit and amplification was performed using the thermocycler CFX96™ Real-Time PCR Detection System (BioRad). The obtained results were compared with the reference assays RealStar® Orthopoxvirus PCR Kit 1.0 (Altona) and Allplex™ Genital ulcer assay (Seegene®). Results After data analysis a very good overall agreement was obtained for all the studied targets. Conclusion The assays under study demonstrated to be a good tool for differential analysis in skin lesions compatible with HSV-1, HSV-2, VZV, T. pallidum or mpox virus infection. In addition, the shared thermal protocol of the assays allowed for the simultaneous detection in the sample, creating a personalized panel option for the user, as opposed to the reference assays employed, which required two separate analyses, taking longer to reach the full assessment of the sample.

A novel recombinant ORF7-siRNA delivered by flexible nano-liposomes inhibits varicella zoster virus infection

BackgroundVaricella zoster virus (VZV), which is a human restricted alpha-herpesvirus, causes varicella (chickenpox) and zoster (shingles). The subsequent post-herpetic neuralgia (PHN) due to VZV infection is excruciating for most patients. Thus, developing specific therapeutics against VZV infection is imperative. RNA interference (RNAi) represents an effective approach for alternative antiviral therapy. This study aimed to develop a novel anti-VZV therapeutics based on RNAi.ResultsIn this study, we screened and found the open reading frame 7 (ORF7) of the VZV genome was an ideal antiviral target based on RNAi. Therefore, a novel siRNA targeting ORF7 (si-ORF7) was designed to explore the potential of RNAi antiviral treatment strategy toward VZV. We used a bio-engineering approach to manufacture recombinant siRNA agents with high yield in E. coli. Then, the efficacy of recombinant ORF7-siRNA (r/si-ORF7) in inhibiting VZV infection both in cellular level and 3D human epidermal skin model was evaluated. The r/si-ORF7 was proved to inhibit the VZV replication and reduce the virus copy numbers significantly in vitro. Furthermore, flexible nano-liposomes were established to deliver r/si-ORF7 to 3D human epidermal skin model and found r/si-ORF7 also could inhibit the VZV infection, thus maintaining normal skin morphology.ConclusionsTaken together, our results highlighted that transdermal administration of antiviral r/si-ORF7 was a promising therapeutic strategy for functional cure of VZV infection.

Features of damage to the nervous system in herpesvirus infections

Actuality. Herpesvirus diseases are characterized by a wide distribution, polymorphism of clinical manifestations and severity of the course up to the development of lethal outcomes. The purpose of the study: to identify the features of the damage to the nervous system in herpes infections in modern conditions. Materials and methods. Under observation there were 60 patients with lesions of the nervous system due to herpesvirus infections, hospitalized in the Infectious Clinical Hospital in 2015-2021. Results and discussion. The analysis of the main clinical and laboratory parameters was carried out and the features of the damage to the nervous system in herpesvirus infections were established. Conclusion. The results of the study showed that patients with VZV infection prevailed among all patients — 78.3%. The range of lesions of the nervous system was presented in the form of serous meningitis (48.3%), meningoencephalitis (43.3%), encephalitis (8.4%).

Increased human immunodeficiency virus viral load with cerebral infarction due to varicella zoster virus vasculopathy on treatment with bictegravir/emtricitabine/tenofovir alafenamide suspension: a case report and literature review

BackgroundVaricella-Zoster virus (VZV) vasculopathy occasionally occurs in immunocompromised patients and is difficult to treat. The risk factor and optimal therapy remain unclear. Patients with human immunodeficiency virus (HIV) and dysphagia or difficulty in oral intake receive antiretroviral therapy (ART) suspension. However, there remains little evidence regarding ART suspension.Case presentationWe experienced a case of a 55-year-old man diagnosed with HIV and severe multiple cerebral infarctions due to VZV vasculopathy. We started on bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) and acyclovir (ACV), and prednisone. He was started on BIC/TAF/FTC suspension because of deteriorated swallowing. The HIV viral load was increased; however, no drug-resistance genes were detected. We successfully treated him with doltegravir/abacavir/lamibudine suspension. We performed two literature reviews of the administration of BIC/TAF/3TC suspension and VZV vasculopathy in patients with HIV. Three cases of BIC/TAF/3TC suspension were considered treatment failures. Recent history of VZV infection and a CD4 count under 200 μL may be risk factors for VZV vasculopathy. The effective treatment may be using steroid and ACV; however, treatment duration could differ.ConclusionsBIC/TAF/FTC suspension administration may be unstable, and treating ACV and steroid may be optimal therapy for VZV vasculopathy; however, the evidence level is low.

THE IMPORTANT OF NEUROPHYSIOLOGY EXAMINATION IN DIAGNOSING SEGMENTAL ZOSTER PARESIS: CASE REPORT

Background: Segmental zoster paresis (SZP) is a very uncommon complication characterized by localized weakening of the upper or lower limbs. Case report: A 69-year-old man came with complaints of weakness in the right leg two months ago. He had weakness in his right leg after two days of having herpes on his right leg. There was paresthesia and hypesthesia on neurological examination according to the L1-L3 dermatome. Neurophysiology examination revealed a neuropathy in the right femoral nerve. Discussion: Varicella-zoster virus, being a neurotrophic virus, primarily invades and incubates in the dorsal root or cerebral ganglion nerve cells. Etiological investigations in SZP patients have revealed that the anterior root is the most prevalent location of inflammation and degeneration. Conclusion: SZP is a rare complication following VZV infection that can lead to misdiagnosis and overtreatment in clinical practice. The neurophysiological examination is very important in diagnosing segmental zoster paresis.

Immunopatological and Genetic Aspects of the Pathogenesisof CNS Lesions in VZV Infection

Immunopatological and Genetic Aspects of the Pathogenesisof CNS Lesions in VZV Infection

The necessity for popularizing varicella-zoster virus vaccine programs worldwide: An age-period-cohort analysis for the Global Burden of Disease study 2019

BackgroundVaricella-zoster virus (VZV) causes varicella and herpes zoster (VHZ), which is endemic worldwide. Although infection with VZV represents a considerable health threat, the global, regional and national burden of VZV infection, especially the probable relationship between VZV vaccines and the epidemiology of VZV infection, is poorly known. We sought to estimate the global spatial patterns and temporal trends of VHZ burden in 204 countries and territories from 1990 to 2019. MethodsNumbers and age-standardized rates (ASR) of VHZ incidence, and disability-adjusted life years (DALYs) were estimated using data from the Global Burden of Diseases Study (GBD) 2019. Spatiotemporal trends in ASR were evaluated by estimated annual percentage change (EAPC). ResultsWorldwide, in 2019, there were approximately 84.0 million incidence and 0.9 million DALYs due to VHZ. The corresponding ASIR (age-standardized incidence rate) and ASDR (age-standardized DALY rate) drastically decreased in children (aged <20 years old), while the ASIR and ASDR of VHZ significantly increased in middle- and old-aged adults (aged >50 years old), with highest ASIR and ASDR in the High-income Asia Pacific and Western Sub-Saharan Africa, respectively. From 1990–2019, the corresponding EAPC in ASIR were 0.03 (95% uncertainty interval [UI]: 0.02–0.04). Whereas the global EAPC in ASDR decreased in all regions (−1.59, 95% UI: −1.64 to −1.55), expect for Australasia (0.46, [0.05, 0.88]). Notably, in 2019, age-specific rates of VHZ DALYs presented a rapid growth trend after 70 years old. ConclusionThe spatiotemporal trends of VHZ were heterogeneous across countries from 1990 to 2019. The spatiotemporal trend in ASIR is highest in the High sociodemographic index (SDI) region, however the EAPC in ASDR is lowest, in part probably due to VHZ vaccination. Therefore, reducing morbidity and burden strategies such as vaccines programs for the prevention of VHZ should be promoted in those regions with high growth incidence and/or burden, especially for the population after 70 years old.

Systematic review with meta-analysis of active herpesvirus infections in patients with COVID-19: Old players on the new field

Herpesviruses are ubiquitous and after primary infection they establish lifelong latency. The impairment of maintaining latency with short-term or long-term consequences could be triggered by other infection. Therefore, reactivation of herpesviruses in COVID-19 patients represents an emerging issue. This study provided the first systematic review with meta-analysis of studies that evaluated active human herpesvirus (HHV) infection (defined as the presence of IgM antibodies or HHV-DNA) in COVID-19 patients and included 36 publications collected by searching through PubMed, SCOPUS, and Web of science until November 2022. The prevalence of active EBV, HHV6, HSV, CMV, HSV1, and VZV infection in COVID-19 population was 41% (95% CI =27%-57%), 3% (95% CI=17%-54%), 28% (95% CI=1%-85%), 25% (95% CI=1%-63%), 22% (95% CI=10%-35%), and 18% (95% CI=4%-34%), respectively. There was a 6 times higher chance for active EBV infection in patients with severe COVID-19 than in non-COVID-19 controls (OR=6.45, 95% CI=1.09-38.13, p=0.040), although there was no difference in the prevalence of all evaluated active herpesvirus infections between COVID-19 patients and non-COVID-19 controls. Future research of herpesvirus and SARS-CoV-2 coinfections must be prioritized to define: who, when and how to be tested, as well as how to effectively treat HHVs reactivations in acute and long COVID-19 patients.

Meningitis without Rash after Reactivation of Varicella Vaccine Strain in a 12-Year-Old Immunocompetent Boy.

Acute neurologic complications from Varicella-Zoster-Virus reactivation occur in both immunocompromised and immunocompetent patients. In this report, we describe a case of a previously healthy immunocompetent boy who had received two doses of varicella vaccine at 1 and 4 years. At the age of 12 he developed acute aseptic meningitis caused by vaccine-type varicella-zoster-virus without concomitant skin eruptions. VZV-vaccine strain DNA was detected in the cerebrospinal fluid. The patient made a full recovery after receiving intravenous acyclovir therapy. This disease course documents another case of a VZV vaccine-associated meningitis without development of a rash, i.e., a form of VZV infection manifesting as "zoster sine herpete".