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The authors present a case of meningoencephalitis caused by Varicella zoster virus (VZV) infection, which initially manifested as orbital myositis followed by rapid progression to orbital apex syndrome, meningoencephalitis and death. There was no development of a cutaneous rash. An orbital biopsy demonstrated VZV infection, which was confirmed on a lumbar puncture. In this case, VZV meningoencephalitis was not responsive to steroid or antiviral therapy. This case highlights an atypical presentation of VZV with orbital myositis preceding intracranial involvement. [ABSTRACT FROM AUTHOR]

This case study documents the case of a 27-year-old female who presented with a complaint of left anterolateral thigh numbness, initially diagnosed as meralgia paresthetica with a differential diagnosis of lumbar radiculopathy. Over a span of two weeks, the patient endured emotional trauma and subsequently developed lesions in the area of complaint. The patient was diagnosed at a medical clinic with herpes zoster and was prescribed anti-viral medication which resulted in complete resolution. This case highlights the importance of considering herpes zoster as a differential diagnosis for nerve-related symptoms. Features of lumbar radiculopathy, meralgia paresthetica, varicella zoster and herpes zoster are discussed, as well as the defining characteristics and treatment options. Practitioners must remain vigilant in suspicion of viral infections such as herpes zoster even with lower incidence due to approved vaccines. [ABSTRACT FROM AUTHOR]

Healthcare workers (HCWs) are occupationally exposed to varicella zoster virus (VZV), and their inappropriate vaccination status could contribute to an outbreak involving both professionals and the patients they care for, with a potential impact on the general population. Therefore, since 2007, the Advisory Committee on Immunization Practices (ACIP) recommends that all HCWs have evidence of immunity against varicella. The present meta-analysis was therefore designed to collect the available evidence on the seronegative status of VZV among HCWs. PubMed, Scopus, and Embase databases were searched without backward limit for articles reporting on the seroprevalence of VZV among HCWs, and all articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 1744 initial entries, a total of 58 articles were included in the quantitative analysis (publication range: 1988 to 2024), for a pooled sample of 71,720 HCWs. Moreover, the included studies reported on seroprevalence data on measles (N = 36,043 HCWs) and rubella (N = 22,086 HCWs). Eventually, the pooled seronegative status for VZV was estimated to be 5.72% (95% confidence interval [95% CI] 4.59 to 7.10) compared to 6.91% (95% CI 4.79 to 9.87) for measles and 7.21% (5.36 to 9.64) for rubella, with a greater risk among subjects younger than 30 years at the time of the survey (risk ratio [RR] 1.434, 95% CI 1.172 to 1.756). Interestingly, medical history of either VZV infection/vaccination had low diagnostic performances (sensitivity 76.00%; specificity 60.12%; PPV of 96.12% but PNV of 18.64%). In summary, the available data suggest that newly hired HCWs are increasingly affected by low immunization rates for VZV but also for measles and rubella, stressing the importance of systematically testing test newly hired workers for all components of the measles–pertussis–rubella–varicella vaccine. [ABSTRACT FROM AUTHOR]

Management of the exposure of pediatric oncology patients to varicella zoster virus (VZV) is controversial. We report the exposure of 56 patients to a single child with chicken pox at a pediatric cancer housing facility and describe our strategic approach for their management. We reviewed the immune and clinical status of 56 children with cancer receiving ongoing treatment at Memorial Sloan Kettering Cancer Center (MSK) who, while living at a pediatric cancer housing facility, were exposed to the index patient. The management of patients exposed included: (1) determination of immune status, (2) availability of vaccination history or VZV disease prophylaxis, (3) exposure status and subsequent isolation during the period of incubation, and (4) VZV disease prophylaxis. In addition to the 56 patients exposed to the index case, eight children with cancer treated at other facilities and 11 healthy siblings living in the facility were exposed. Of the 56 MSK patients, 21 were classified as immunosuppressed and received varicella zoster immune globulin (human), intravenous standard immune globulin, or acyclovir based on serostatus and immune function. The cohort was followed for 4 weeks after the exposure and no secondary infections were diagnosed. We performed a risk assessment and created a management plan to control and prevent further exposure and development of disease. No secondary cases developed. This strategic approach could serve as a model for the management of VZV exposure for other pediatric oncology centers. [ABSTRACT FROM AUTHOR]

Background/Aims Vedolizumab (VDZ) is a gut-selective agent with a favorable safety profile. We aimed to assess the feasibility of elective switch from other advanced therapies to VDZ and subsequent live-attenuated vaccination while continuing VDZ in patients with inflammatory bowel diseases (IBD). Methods We measured antibody titers specific for measles, rubella, mumps, and varicella viruses in IBD patients under immunosuppressive therapy. Those with negative titers and without vaccination history were judged unimmunized. Patients were administered vaccines while continuing VDZ or switched to VDZ if receiving other advanced therapies and then administered vaccines. Co-primary outcomes were the rate of maintaining disease severity after vaccination and the rate without vaccine-induced infection. Results Among 107 unimmunized patients, 37 agreed to receive live-attenuated vaccines while continuing VDZ (17 patients) or after switching to VDZ (20 patients). In the 20 patients who electively switched to VDZ, disease severity was maintained except for 1 patient who developed intestinal infection. After 54 weeks, 18 patients (90%) continued to receive VDZ, excluding 2 patients who reverted to their originally administered biologics. In all 37 patients administered live-attenuated vaccines under VDZ treatment, disease severity was maintained after vaccination. Antibody titers became positive or equivocal in 34 patients (91.9%). There were no cases of vaccine-induced infection during a median observation period of 121 weeks. Conclusions While live-attenuated vaccines are contraindicated under immunosuppressive therapy, they may be safely administered while receiving VDZ immunotherapy. Switching from other advanced therapies to VDZ and subsequently receiving live-attenuated vaccines may be a safe alternative in unimmunized patients.

Phillip R Kramer,1 Rebecca S Hornung,1 Mikhail Umorin,1 M Douglas Benson,1 Paul R Kinchington2 1Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX, USA; 2Department of Ophthalmology and of Molecular Microbiology and Genetics, University of Pittsburgh, Pittsburgh, PA, USACorrespondence: Phillip R Kramer, Email pkramer@tamu.eduIntroduction: Herpes Zoster in humans is the result of varicella zoster virus (VZV) infection. Injecting rats with varicella zoster virus produces pain similar to herpes zoster “shingles” pain in humans. . In a previous study, orofacial pain was induced by injecting the whisker pad of male rats with VZV and the pain response increased after attenuating neurexin 3 (Nrxn3) expression in the central amygdala. Neurons descend from the central amygdala to the lateral parabrachial nucleus and orofacial pain signals ascend to the lateral parabrachial nucleus. GABAergic neurons within the central amygdala regulate pain by inhibiting activity within the lateral parabrachial nucleus. Attenuating Nrxn3 expression in the central amygdala increased GABA release in the lateral parabrachial nucleus suggesting Nrxn3 controls pain by regulating GABA release. Nrxn3 can also control synaptic connections between neurons, and we hypothesized that Nrxn3 knockdown in the central amygdala would reduce the number of GABAergic synaptic connections in the lateral parabrachial nucleus and increase VZV associated pain.Methods: To test this idea, the number of synaptic connections between GABAergic cells of the central amygdala and excitatory or dynorphin positive neurons within the lateral parabrachial nucleus were quantitated after infusion of a virus expressing synaptophysin. Synaptophysin is a synaptic vesicle protein that labels neuronal synaptic connections. These connections were measured in rats with and without whisker pad injection of VZV and knockdown of Nrxn3 within the central amygdala. Orofacial pain was measured using a place escape avoidance paradigm.Results: GABAergic synaptic connections were reduced in the lateral parabrachial nucleus after Nrxn3 knockdown. Rats with a reduction in the number of connections had an increase in VZV associated orofacial pain. Immunostaining with the pain marker prodynorphin indicated that the reduction in GABAergic connections was primarily associated with prodynorphin positive neurons.Discussion: The results suggest Nrxn3 reduces VZV associated orofacial pain, in part, by enhancing synaptic connections between GABA cells of the central amygdala and pain neurons within the lateral parabrachial nucleus.Keywords: orofacial pain, zoster, shingles, varicella zoster, post-herpetic neuralgia, synaptic plasticity

Background/Aims: Vedolizumab (VDZ) is a gut-selective agent with a favorable safety profile. We aimed to assess the feasibility of elective switch from other advanced therapies to VDZ and subsequent live-attenuated vaccination while continuing VDZ in patients with inflammatory bowel diseases (IBD). Methods: We measured antibody titers specific for measles, rubella, mumps, and varicella viruses in IBD patients under immunosuppressive therapy. Those with negative titers and without vaccination history were judged unimmunized. Patients were administered vaccines while continuing VDZ or switched to VDZ if receiving other advanced therapies and then administered vaccines. Co-primary outcomes were the rate of maintaining disease severity after vaccination and the rate without vaccine-induced infection. Results: Among 107 unimmunized patients, 37 agreed to receive live-attenuated vaccines while continuing VDZ (17 patients) or after switching to VDZ (20 patients). In the 20 patients who electively switched to VDZ, disease severity was maintained except for 1 patient who developed intestinal infection. After 54 weeks, 18 patients (90%) continued to receive VDZ, excluding 2 patients who reverted to their originally administered biologics. In all 37 patients administered live-attenuated vaccines under VDZ treatment, disease severity was maintained after vaccination. Antibody titers became positive or equivocal in 34 patients (91.9%). There were no cases of vaccine-induced infection during a median observation period of 121 weeks. Conclusions: While live-attenuated vaccines are contraindicated under immunosuppressive therapy, they may be safely administered while receiving VDZ immunotherapy. Switching from other advanced therapies to VDZ and subsequently receiving live-attenuated vaccines may be a safe alternative in unimmunized patients. [ABSTRACT FROM AUTHOR]

The diagnosis of a congenital infection leads to feeling of anxiety and fear not only the pregnant woman but also in the medical practitioner caring for the woman. This is not surprising given that these conditions are rare events and so each clinician may only see a handful in their career. This article gives practical advice for when to suspect congenital infection, and to provide a framework for investigation, counselling and management of seven important congenital infections: toxoplasmosis, cytomegalovirus (CMV), zika virus, parvovirus B19, rubella, syphilis, and varicella zoster. [ABSTRACT FROM AUTHOR]

Background: Varicella (chickenpox) is a febrile rash illness resulting from a primary infection with the varicella-zoster virus (VZV). The disease is more prevalent in children than adults. Adults when affected manifest severe symptoms. Material and Methods: Following a sudden increase in cases in April 2023, an outbreak investigation and a matched case-control study were conducted, to assess the risk of varicella transmission among hostel inmates of a tertiary care center in Kalaburagi. Based on the clinical diagnosis, 8 cases and 32 controls matched for gender and year of course were chosen. The survey was conducted using an epidemiological case sheet, containing students' sociodemographic profile and clinical history, after obtaining written consent. Data was entered in an Excel sheet and analysed using JAMOVI software. The outbreak was described in terms of time, place, and person using descriptive statistics. The odds ratio was calculated to assess the strength of the association between risk factors and varicella infection. Results: The index case, 22 years old was detected on 7th April, 2023 in boys hostel following which 7 more students were affected with a secondary attack rate of 6.93%. Mean (SD) age of cases was 20.13(1.36) years and males (75%) were most commonly affected. Majority (62.5%) presented with moderate lesions with none developing complications. All cases were identified and isolated (mean duration of 12.75(3.93) days) with strict precautions. Personal protective measures usage was significantly protective against varicella among risk factors, with an odds ratio of 0.09 (95% CI 0.01,0.51). Conclusion: With the help of active case finding, isolation, and vaccination campaigns, the outbreak was successfully controlled. [ABSTRACT FROM AUTHOR]

After primary infection, Varicella Zoster (VZV) persists in sensory dorsal root ganglia and may be reactivated in periods of diminished T-cell immunity. Varicella Zoster reactivation post allogenic stem cell transplantation (HSCT) can be challenging to diagnose as it does not always present with characteristic skin lesions. We describe a pediatric patient who presented with isolated severe abdominal pain with no other symptoms. Cutaneous lesions appeared only 10 days later resulting in delayed diagnosis and treatment. He was successfully treated with intravenous acyclovir and recovered after a prolonged hospital stay with post-herpetic neuralgia. Abdominal pain in children post HSCT has a broad differential and VZV reactivation should be considered even in absence of cutaneous lesions. Early diagnosis and treatment are essential to reduce VZV-related morbidity and mortality. In this article we present a case report and review clinical presentation and outcome of similar cases in the literature. [ABSTRACT FROM AUTHOR]

Varicella zoster is found exclusively in humans. Infected people with this virus result in chickenpox followed by dormant virus within neural ganglia. This dormant virus, once activated, may affect any ganglia or nerves of the body but most commonly involves the thoracic, cervical and trigeminal nerves in decreasing order of frequency. We review three such cases in which manipulation of the trigeminal ganglion resulted in reactivation of varicella at homologous operative sites. Each patient underwent surgeries in which the trigeminal ganglion was manipulated for the resection of trigeminal schwannoma under a microscope through various approaches. All three patients developed reactivation of varicella at homologous operative sites. A thorough history of chickenpox infection should be taken in patients who are undergoing surgeries for trigeminal pathology. Early diagnosis should be made once any vesicular lesions are seen with prompt treatment. Reassurance and counselling are necessary in these patients. If possible, prophylaxis may be started in all such patients. Further studies are warranted to determine the exact cause of reactivation. [ABSTRACT FROM AUTHOR]

Introduction: Varicella zoster virus (VZV) causes infection of the central nervous system, which manifests as various neurological syndromes. In this case series, we discuss three different clinical presentations of VZV reactivation (herpes zoster). The main clinical feature of herpes zoster is a pruritic vesicular rash, present in a dermatomal distribution, which occurs after reactivation of the virus because of immunosuppression. Patients presentation: We report on three individual cases of complicated herpes zoster that resulted in various neurological pathologies. The patients described in this case series each received a lumbar puncture with cerebrospinal fluid analysis, which showed a positive varicella zoster polymerase chain reaction test (VZV PCR). Management and outcome: All three patients received intravenous acyclovir as their core component of treatment. In addition to this, some received other adjunctive treatments, mainly corticosteroids. Two patients achieved disease resolution while one patient demised. Conclusion: The case series highlights the various ways in which VZV can affect the central nervous system (CNS) such as meningitis, encephalitis, myelitis and arteritis. Contribution: This is a brief overview of the clinical manifestations of VZV affecting the CNS in patients presenting to a regional hospital within the Western Cape province in South Africa.

Healthcare workers (HCWs) are occupationally exposed to varicella zoster virus (VZV), and their inappropriate vaccination status could contribute to an outbreak involving both professionals and the patients they care for, with a potential impact on the general population. Therefore, since 2007, the Advisory Committee on Immunization Practices (ACIP) recommends that all HCWs have evidence of immunity against varicella. The present meta-analysis was therefore designed to collect the available evidence on the seronegative status of VZV among HCWs. PubMed, Scopus, and Embase databases were searched without backward limit for articles reporting on the seroprevalence of VZV among HCWs, and all articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 1744 initial entries, a total of 58 articles were included in the quantitative analysis (publication range: 1988 to 2024), for a pooled sample of 71,720 HCWs. Moreover, the included studies reported on seroprevalence data on measles (N = 36,043 HCWs) and rubella (N = 22,086 HCWs). Eventually, the pooled seronegative status for VZV was estimated to be 5.72% (95% confidence interval [95% CI] 4.59 to 7.10) compared to 6.91% (95% CI 4.79 to 9.87) for measles and 7.21% (5.36 to 9.64) for rubella, with a greater risk among subjects younger than 30 years at the time of the survey (risk ratio [RR] 1.434, 95% CI 1.172 to 1.756). Interestingly, medical history of either VZV infection/vaccination had low diagnostic performances (sensitivity 76.00%; specificity 60.12%; PPV of 96.12% but PNV of 18.64%). In summary, the available data suggest that newly hired HCWs are increasingly affected by low immunization rates for VZV but also for measles and rubella, stressing the importance of systematically testing test newly hired workers for all components of the measles–pertussis–rubella–varicella vaccine.

Aim: The aim of this study is to investigate the effectiveness of our treatment methods applied in the pain management of patients with HZ, PHN and risk factors associated with the development of HZ and PHN . Materials and Methods: The study was conducted in our hospital pain medicine clinic. The demographic data of the patients, in which phase of the disease they admitted, in which dermatomes the disease was occurred, what medical treatments they received and type of interventional treatments were applied between the dates of January 2019 and January 2023 were recorded. Also, pain reduction was evaluated as beneficial when there's a reduction in the pain level equal or more than 50%, and below as useless. The dosage scheme and types of drugs used were recorded. The follow-up interval was determined as 6 weeks after the intervention. Results: While 131 (56.2%) of 233 patients were diagnosed with HZ, 102 patients (43.8%) were diagnosed as PHN. The median age was significantly higher in the PHN group (p<0.001). Thoracic region (60.9%) is the most frequently involved dermatome for HZ and PHN, followed by lumbar, trigeminal nerve ophthalmic branch and cervical region. The most commonly used agents are pregabalin, tramadol and gabapentin, respectively. Interventional treatments, on the other hand, were generally effective regardless of the phase. Conclusion: It has been determined sympathetic blocks and epidural injections in acute and subacute periods are more effective, and peripheral nerve blocks are effective in both periods. While it was found to be effective the pulse radiofrequency in lumbar region, it was found to be effective in the chronic period while it was not effective in the facial dermatome in the acute period. [ABSTRACT FROM AUTHOR]

Herpes Zoster (HZ) is a reactivation of the Varicella Zoster Virus (VVZ), which is characterized by an acute unilateral vesicular eruption grouped with radicular pain around the dermatome. The incidence of HZ increases with age and is rare in children. The prevalence of HZ in children can occur, if they have a history of primary intrauterine infection, are immunocompromised, and who are infected with varicella in the first year of life. One daughter, Ms. B, 15 years old, came to the Skin and Venereology Clinic, PKU Muhammadiyah Surakarta Hospital on December 28, 2022 with complaints of itching and heat, a lesion in the form of multiple clustered vesicles, round in shape, with a size of 0.3-0.5 cm above the skin, erythematous, unilateral, not crossing the midline, the age of the vesicles in one group is the same, but with other groups it is not the same, the skin between groups is normal. Treatment was given acyclovir 4x800 mg per day taken orally for 5 days, triamcinolone 4 mg/day, compressed NaCl 15 minutes 2x daily, caaladine lotion 2x daily on intact lesions and mupirocin calcium on open wounds. [ABSTRACT FROM AUTHOR]

This article examines two conditions in which neurological symptoms prominently manifest alongside dermatological manifestations. The first condition, Rosolimo–Melkersson–Rosenthal syndrome, encompasses three cardinal features: macrocheilia, fissured tongue, and facial nerve palsy, with macrocheilia often presenting as the monosymptom. When the clinical presentation is limited to macrocheilia, dermatologists typically manage the treatment, while cases with evident facial nerve palsy are referred to neurologists. The second condition is herpes zoster, the clinical manifestations of which unequivocally necessitate dermatological intervention. Apart from cutaneous eruptions, the primary focus shifts to neurological involvement, presenting as neuropathic disorders (agonizing pain syndromes concurrent with eruptions) and post-herpetic neuralgia, which can endure for an extended period. Consequently, the management of such patients involves collaboration between dermatologists and neurologists.

The vaccination with live attenuated vaccines is generally not recommended during natalizumab (NTZ), as it is included among immunosuppressive/immunomodulating therapies. Nevertheless, considering the lack of evidence of a non-Central Nervous System (CNS) immunosuppressive effect of NTZ, after a risk/benefit evaluation, we decided to vaccinate four multiple sclerosis (MS) patients (three with an indication to switch to ocrelizumab for high-risk Progressive Multifocal Leukoencephalopathy (PML) and one for pregnancy planning). No vaccine-related adverse events of any type nor varicella zoster virus (VZV) infections were observed. To the best of our knowledge, these case series represent the first description of the good safety profile of anti-VZV vaccination in MS patients during NTZ treatment. [ABSTRACT FROM AUTHOR]

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Purpose: While typically affecting older adults and immunocompromised individuals, herpes zoster ophthalmicus (HZO) has been reported with varying manifestations and complications in children. In this review, we evaluate reported cases of pediatric HZO in the literature and discuss the epidemiology, risk factors, clinical presentation, treatment and outcomes. Methods: A literature search on PubMed, Scopus, and Web of Science databases was performed using the terms "pediatric herpes zoster ophthalmicus" and "herpes zoster ophthalmicus children." Publications that were not specific to HZO or pediatric populations were excluded, as were publications that were not available to review or not published in the English language. Results: Fifty-seven reports describing 130 cases of HZO or HZO-related complications were reviewed. Major risk factors for pediatric HZO included intrauterine exposure to varicella or primary varicella infection at a young age; HZO also occurred in patients who had received varicella vaccination. Both healthy and immunocompromised children were affected, with the majority of affected children being immunocompetent. The diagnosis of HZO is primarily clinical. Children appear to have good vision recovery and resolution of symptoms if they are treated promptly and if they adhere to treatment regimens, except for irreversible vision loss related to uncommon complications such as optic neuritis. Conclusion: HZO occurs in both healthy and immunocompromised children. Recognizing this treatable condition is essential for reducing ocular and systemic morbidity. Long-term follow-up and assessments of the impact on health in adulthood are lacking. More systematic study is needed to determine the incidence of HZO in children and appropriate diagnostic and treatment protocols for the care of pediatric patients with HZO. [ABSTRACT FROM AUTHOR]

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.

Laryngeal herpes is a rare entity. Varicella zoster virus (VZV) can involve the pharyngolaryngeal region and cranial nerves. The first contact with this virus, transmitted by airborne particles shed from the skin of an infected person, produces symptoms. After resolution of symptoms, VZV travels to the dorsal root ganglia of the spinal cord, where it remains dormant for years. Reactivation of the virus occurs secondary to impaired cellular immunity. A case of a 60-year-old man presented with a change in voice and difficulty in swallowing. Another case of a 75-year-old woman presented with a change in voice, sore throat, and right facial palsy. In both cases, flexible laryngoscopy showed vesicles on the right side of the larynx. Cases were confirmed by laryngeal swab PCR testing. Both cases were treated with oral steroids and oral antiviral valacyclovir 500 mg three times a day for 10 days. This clinical condition should be kept in mind when a patient presents with unilateral sore throat and voice change. [ABSTRACT FROM AUTHOR]

Key Clinical Message There are dermatoses that arise within healed zosteriform sites, such as granulomas annulare, acneiform eruptions, psoriasis, lichen planus, and giant cell lichenoid dermatitis “GCLD.” Nonetheless, graft‐versus‐host disease should be considered and ruled out, especially in patients post‐bone marrow transplant. Herein, we report a case of GCLD manifesting within healed zosteriform sites.

Varicella vaccination in children has been performed worldwide in recent years. Despite established effectiveness, many countries still do not routinely vaccinate children against varicella, probably due to concerns about complications, such as herpes zoster infection. We aimed to compare the herpes zoster incidence in children before and after implementing the mandatory varicella vaccine in Israel in 2008. As a secondary aim, we characterized several parameters, including age, sex, and ethnic sector among herpes zoster cases, and we evaluated the complication rate to identify data relevant to the immunization status of the pediatric population. A retrospective study was conducted between 2000 and 2021, including patients aged 0–18 years old in a large cohort in southern Israel. A time series analysis and complication rates evaluations were performed in the pre- and post-vaccination eras. A total of 109.24 herpes zoster cases per 100,000 population per year were diagnosed between 2000 and 2007 (pre-vaccination era), compared to 354.71 herpes zoster cases per 100,000 population per year diagnosed between 2008 and 2021 (post-vaccination era) (p < 0.001). No change in the complication rate was documented. Thus, we concluded that there is an association between the varicella vaccine implementation program and the increase in the rate of herpes-zoster occurrence without a concurrent negative contribution to herpes zoster-related morbidity. [ABSTRACT FROM AUTHOR]

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive large intracranial artery narrowing and development of small vessel collaterals. Moyamoya syndrome (MMS) refers to the angiographic findings of MMD with predisposing medical conditions. Varicella-associated cerebral vasculopathy (VACV) is a severe complication of varicella zoster virus (VZV) infection and its association with MMS is rare in adult. We report on a case of a 55-year-old lady who presented with progressively worsening dysphasia and left lower limb weakness following a week of right herpes zoster ophthalmicus infection. The initial Magnetic Resonance Imaging (MRI) of brain demonstrated features of encephalitis with micro abscesses. Her serial repeated MRI brain imagings subsequently demonstrated worsening of cerebral infarctions with right internal carotid artery stenosis and basal ganglia collaterals suggestive of Moyamoya vasculopathy. This case highlights the rare association of VACV with MMS and should be considered as a potential serious complication in patients with VZV infection. [ABSTRACT FROM AUTHOR]

Post-herpetic neuralgia (PHN) is an entity derived from peripheral nerve damage that occurs during the reactivation of the Varicella Zoster Virus (VZV), which manifests itself through pain with neuropathic characteristics. This can prove to be very difficult to manage in the chronic stages of disease reappearance. There currently exists a multitude of treatment alternatives for PHN, however, prevention through the early initiation of antiviral regimens is vital. There are various pharmacological options available, but it is important to individualize each patient to maximize efficacy and minimize adverse effects. Interventional procedures have become a cornerstone in difficult-to-manage cases, and have shown promising outcomes when used in a multimodal approach by experienced specialists. It is necessary to make an objective diagnosis of PHN and start early treatment. Additionally there is current evidence that vouches for interventional therapies as well as individualization, with a clear establishment of therapeutic objectives according to the needs of each patient. [ABSTRACT FROM AUTHOR]

Background and purpose: Patients with multiple sclerosis (MS) under certain disease‐modifying therapies (DMT) show a higher risk of infection and a lower immune response to vaccination. Hence, assessing immunization status prior to DMT start and, where necessary, performing vaccinations is recommended. We aimed to determine the immunization status in MS patients and to identify factors associated with low vaccination rates. Methods: Patients with MS who were seen at the MS clinic of the Medical University of Innsbruck throughout a period of 14 months in 2020 and 2021 were eligible for inclusion into this prospective, single‐center study. Immunization status against 17 different pathogens was obtained from vaccination certificate and by patient questionnaire. Antibody detection against seven antigens was performed in peripheral blood. Results: Of 424 patients with MS at a mean age of 43 ± 12 years, the vast majority had vaccinations against tetanus (94%), diphtheria (92%), and poliomyelitis (90%), whereas a lower proportion had vaccinations against tick‐borne encephalitis (70%), pertussis (69%), hepatitis B (65%), rubella (55%), hepatitis A (50%), measles (49%), mumps (47%), and only a minority against influenza (10%), pneumococcal (6%) and meningococcal disease (4%), human papillomavirus (4%), yellow fever (2%), and varicella zoster virus (1%). A total of 87% received vaccination against SARS‐CoV‐2. Overall, higher vaccination rates were associated with younger age, relapsing disease course, and education level. Misinformation on infectious diseases and vaccines was associated with lower vaccination rates. Conclusions: The majority of MS patients did not fulfil vaccination recommendations. Efforts to increase vaccination rates, preferentially before DMT start, should be promoted. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate choroidal lesions with spectral domain optical coherence tomography (SD-OCT) scan in varicella zoster virus (VZV) uveitis. Methods: VZV-uveitis cases which underwent OCT scan for choroidal lesions were studied. SD-OCT scan passing through these lesions was studied in detail. Subfoveal choroidal thickness (SFCT) during active and resolved stages was studied. Angiogaphic features were studied where available. Results: Thirteen out of 15 cases had same-sided herpes zoster ophthalmicus skin rashes. All except three patients had old or active kerato-uveitis. All eyes demonstrated clear vitreous and a single or multiple hypopigmented orangish-yellow choroidal lesions. The number of lesions remained unchanged during the follow-up on clinical examination. SD-OCT over lesions (n = 11) showed choroidal thinning (n = 5), hyporeflective choroidal elevation during active inflammation (n = 3), transmission effects (n = 4), and ellipsoid zone disruption (n = 7). The mean change in SFCT (n = 9) after resolution of the inflammation was 26.3 µm (range: 3--90 µm). Fundus fluorescein angiography showed iso-fluorescence over lesions in all (n = 5), but indocyanine green angiography (n = 3) showed hypofluorescence at lesions. Mean follow-up was 1.38 years (range: 3 months--7 years). De-novo appearance of choroidal lesion during the first relapse of VZV-uveitis was captured in one case. Conclusion: VZV-uveitis can cause focal or multifocal hypopigmented choroidal lesions with thickening or scarring of choroidal tissue, depending on the disease activity. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate choroidal lesions with spectral domain optical coherence tomography (SD-OCT) scan in varicella zoster virus (VZV) uveitis. Methods: VZV-uveitis cases which underwent OCT scan for choroidal lesions were studied. SD-OCT scan passing through these lesions was studied in detail. Subfoveal choroidal thickness (SFCT) during active and resolved stages was studied. Angiogaphic features were studied where available. Results: Thirteen out of 15 cases had same-sided herpes zoster ophthalmicus skin rashes. All except three patients had old or active kerato-uveitis. All eyes demonstrated clear vitreous and a single or multiple hypopigmented orangish-yellow choroidal lesions. The number of lesions remained unchanged during the follow-up on clinical examination. SD-OCT over lesions (n = 11) showed choroidal thinning (n = 5), hyporeflective choroidal elevation during active inflammation (n = 3), transmission effects (n = 4), and ellipsoid zone disruption (n = 7). The mean change in SFCT (n = 9) after resolution of the inflammation was 26.3 μm (range: 3–90 μm). Fundus fluorescein angiography showed iso-fluorescence over lesions in all (n = 5), but indocyanine green angiography (n = 3) showed hypofluorescence at lesions. Mean follow-up was 1.38 years (range: 3 months–7 years). De-novo appearance of choroidal lesion during the first relapse of VZV-uveitis was captured in one case. Conclusion: VZV-uveitis can cause focal or multifocal hypopigmented choroidal lesions with thickening or scarring of choroidal tissue, depending on the disease activity.

Varicella zoster reactivation is an increasingly recognised event following mRNA COVID-19 vaccination. In addition, various ocular inflammatory and infectious adverse events following COVID-19 vaccination have been described in the literature. This case report describes acute retinal necrosis (ARN) secondary to varicella zoster virus (VZV) reactivation following COVID-19 mRNA vaccination. A 42-year-old immunocompetent man developed left ARN 12 days following first dose of Pfizer BioNTech mRNA COVID-19 vaccination. Aqueous and vitreous tap polymerase chain reaction testing was positive for VZV. Good visual outcome was achieved with combination therapy, including intravitreal foscarnet, oral valaciclovir and prednisolone, topical dexamethasone and atropine, and barrier retinal laser. Second dose of the vaccine is planned under cover of high-dose oral valaciclovir therapy. This case illustrates the possible association between COVID-19 vaccination and potentially blinding VZV reactivation. Therefore, prompt ophthalmic assessment is recommended in patients with visual disturbance following COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Among 128 adult people living with HIV and no neurological conditions confounding the cerebrospinal fluid results, the presence of HSV-1 chronic infection (detected either by serology or PCR), but not of HSV-2 and VZV, independently associated with higher odds of blood–brain barrier impairment, abnormally increased cerebrospinal fluid levels of tau and phosphorylated-181 tau, and decreased concentrations of fragments 1–42 of beta amyloid compared to the seronegative counterpart. These associations were even stronger for seropositive participants with a positive history of at least one symptomatic reactivation of HSV-1. [ABSTRACT FROM AUTHOR]

Therefore, "Sniffin' Sticks" phenylethylalcohol (PEA) olfactory threshold test and "U-Sniff" odor identification test were conducted (Burghart Messtechnik, Holm, Germany).[2] When asked about olfactory disturbance, the patient reported about phantosmia since the beginning of earache. Keywords: olfactory dysfunction; varicella zoster; Ramsey Hunt syndrome EN olfactory dysfunction varicella zoster Ramsey Hunt syndrome 2751 2753 3 09/21/23 20231001 NES 231001 INTRODUCTION I Varicella zoster virus i ( I VZV i ) is a highly contagious DNA virus, which causes varicella (chickenpox). Only one case report including two men suffering from olfactory impairment and parosmia with Ramsey Hunt syndrome was published.[1] Both suffered from loss of olfactory function and one patient reported additionally about parosmia. [Extracted from the article]

Key Clinical Message: There are dermatoses that arise within healed zosteriform sites, such as granulomas annulare, acneiform eruptions, psoriasis, lichen planus, and giant cell lichenoid dermatitis "GCLD." Nonetheless, graft‐versus‐host disease should be considered and ruled out, especially in patients post‐bone marrow transplant. Herein, we report a case of GCLD manifesting within healed zosteriform sites. [ABSTRACT FROM AUTHOR]

Abstract Background HIV infection is associated with an increased risk of morbidity and mortality from vaccine preventable infections. This research describes, in the context of changing patient demographics, the seroprevalence of vaccine preventable viral infections among attendees of the largest centre for HIV positive patients in Ireland. Methods Baseline serum IgG results for measles, mumps, rubella, varicella zoster virus (VZV) & hepatitis A, as well as hepatitis B sAg, cAb and sAb results, were retrieved for 2534 clinic attendees attending in 2018. Results were available for between 990 and 2363 attendees (39–93%), depending on the test, and were compared with 2013 clinic data. Results There was a 35% increase in attendees in 2018 when compared to 2013. The largest increase was in attendees of South American origin. In 2018, males accounted for 73% of the entire cohort and the HIV acquisition risk for 48% of attendees was MSM. 47% of attendees were originally from Ireland. Among those tested, 33% were susceptible to at least one component of the MMR vaccine. 5% were VZV non-immune (significantly associated with younger age and the acquisition risk status of injection drug use). 21% were hepatitis A non-immune (significantly associated with younger age and being of European or South American origin). 32% were hepatitis B cAb seropositive (significantly associated with older age, injection drug use status and being originally from Africa). 3% demonstrated hepatitis B sAg positivity. 64% had hepatitis B sAb ≥ 10mIU. Conclusion In a cohort of attendees to an HIV clinic in a large urban setting, the susceptibility to several common vaccine preventable viral infections, in particular MMR and hepatitis A and B, was high. These results highlight the importance of proactive screening and immunisation to help protect this high risk patient group against vaccine preventable diseases.

The infection with varicella-zoster virus in immune-deficient patients is an important and complex challenge in treating patients and requires decisions on an individual basis. Rituximab is an anti-CD20 positive B cells monoclonal antibody. Nowadays, it is frequently used in patients with idiopathic nephrotic syndrome and makes them susceptible to various infections. In this study, we report a 16-year-old male subject with steroid-resistant nephrotic syndrome who developed a severe and generalized form of chicken pox following rituximab administration. [ABSTRACT FROM AUTHOR]

In Sudan, data on varicella infections are lacking and the vaccine is currently not in use. The aim of this study was to investigate previous exposure to varicella zoster virus (VZV) among children and adults from the general population and among health-care workers (HCWs) in Khartoum. Dried blood spot samples collected between 2015 and 2016 from 294 children aged 1‒15 years, 153 adult volunteers and 241 HCWs were investigated for the presence of VZV IgG antibodies using ELISA. The overall seroprevalence of VZV IgG antibodies among the investigated cohorts was 50.4%, ranging between 14.3% in children and 79.3% in HCWs. Seropositivity increased with age among children and HCWs (P ⩽ 0.05). A relatively low seropositivity (64.7%) was observed among young adults and HCWs, suggesting that a high proportion of Sudanese adults remain susceptible. In hospital settings, this result implies a risk of nosocomial infection involving both HCWs and vulnerable patients. The results of this first VZV study in Sudan suggest active virus circulation in different age groups. Especially HCWs at the start of their career might benefit from vaccination, not only to save themselves from herpes zoster and its sequelae, but also to indirectly protect vulnerable patients. [ABSTRACT FROM AUTHOR]

Background Pericarditis and pericardial effusion are relatively common hospital presentations, which rarely result in cardiac tamponade. The aetiology is often undetermined and presumed idiopathic or viral. This article reviews varicella zoster virus (VZV)–associated pericardial effusion and peri/myopericarditis and constitutes the first report of VZV-associated cardiac tamponade in the adult population. Case summary We report the case of a 59-year-old woman who presented to hospital with pleuritic chest pain, haemodynamic instability, and a recent herpes zoster rash in the left T1 distribution. Computed tomography revealed a large pericardial effusion, and echocardiography showed features of cardiac tamponade. The patient was treated with pericardial drainage. Aspirate analysis revealed abundant polynuclear cells and histocytes with no organism. Polymerase chain reaction did not determine a cause. Discussion There are 13 reported cases of VZV-associated peri/myopericarditis in adults in the literature published in the English language. Of these, only three patients had a pericardial effusion. Aetiological diagnosis of an effusion is challenging and rarely made on virological grounds but rather on clinical features. Varicella zoster virus–associated pericardial effusion should be considered in patients presenting with haemodynamic instability and a dermatomal rash affecting the C3–C5 and T1–T4 distributions. [ABSTRACT FROM AUTHOR]

Herpes zoster or shingles is a skin disease with the appearance of an air-filled rash accompanied by itching and burning. This disease is caused by the Varicella zoster virus (VZV). Pharmacological therapy performed to treat herpes zoster relies on several types of antivirals, such as acyclovir, valacyclovir, famciclovir, nativudin, sorivudin and others. The antivirus is effective against VZV but there are differences in the working mechanism, bioavailability, and others that can affect the effectiveness of the antivirus. To find out how effective the antivirus is, data is collected from journals related to topics related to it. The method used in this journal review is the collection of literacy from several international journals. The results of the research are there are comparable qualifications among these antivirals such as complete cure, pain relief, wound drying, new lesion formation, safety, complications and side effects. But there are also those who make the antivirus specific under certain conditions. [ABSTRACT FROM AUTHOR]

In Sudan, data on varicella infections are lacking and the vaccine is currently not in use. The aim of this study was to investigate previous exposure to varicella zoster virus (VZV) among children and adults from the general population and among health-care workers (HCWs) in Khartoum. Dried blood spot samples collected between 2015 and 2016 from 294 children aged 1‒15 years, 153 adult volunteers and 241 HCWs were investigated for the presence of VZV IgG antibodies using ELISA. The overall seroprevalence of VZV IgG antibodies among the investigated cohorts was 50.4%, ranging between 14.3% in children and 79.3% in HCWs. Seropositivity increased with age among children and HCWs (P ⩽ 0.05). A relatively low seropositivity (64.7%) was observed among young adults and HCWs, suggesting that a high proportion of Sudanese adults remain susceptible. In hospital settings, this result implies a risk of nosocomial infection involving both HCWs and vulnerable patients. The results of this first VZV study in Sudan suggest active virus circulation in different age groups. Especially HCWs at the start of their career might benefit from vaccination, not only to save themselves from herpes zoster and its sequelae, but also to indirectly protect vulnerable patients. [ABSTRACT FROM AUTHOR]

The aim of the study. Determination of immune response mediators in patients with infection caused by the Varicella Zoster virus with various clinical and laboratory parameters.Materials and methods. Determination of VZV DNA by the polymerase reaction method. The blood content of proinflammatory mediators was assessed using the ELISA method using monoclonal antibodies (Protein contour, Petersburg).Research result. In patients with VZV the content of INF-α, INF-γ, CD-8+ was significantly lower than in patients with a typical form of the disease. In patients with a typical course of the disease, the DNA of the virus was less often determined.Discussion. In patients with pustular chickenpox, the level of IL-1β and CD-4+ was significantly lower than in the typical course of the disease.Conclusions. A decrease in the content of immune response mediators and indicators of cellular immunity in children with chickenpox is an indication for vaccination.

An effective vaccine for chicken pox has been included in immunisation schedules since the 1990s. In the UK the recommendation for routine inclusion came in November 2023; it has not yet been implemented. We explored paediatricians' attitudes towards the vaccine and their personal and professional use; as this has been shown to be an influential factor in parents' vaccine decision making. We conducted a cross-sectional online survey using a structured questionnaire exploring attitudes and knowledge towards the chicken pox vaccine of UK based paediatricians between June and September 2023. We received 272 responses, 211 female (78%), 228 based in England (85%) with remainder in Wales (23), Scotland (8) and Northern Ireland (9); 150 (56%) reporting practicing paediatrics <10 years. The majority (n = 207; 78%) agreed that the chicken pox vaccine should be included in the UK routine schedule. Half the cohort, 52% (n = 135), reported having their own children vaccinated against chicken pox, 73% of those with appropriately aged children. Most, 86% (n = 225), recommended the vaccine to family and friends routinely or when asked; however, 42% (n = 108) did not feel able to advise patients' parents due to insufficient information. Of those who do not recommend the vaccine to family and friends, 22 (59%) reported insufficient information to discuss in a professional setting. Of those who did not think it should be included, or were unsure, 38/55 (69%) also felt they had insufficient information to advise parents regarding the vaccine. Whilst many paediatricians choose to vaccinate their children and agreed the chicken pox vaccine should be added to the routine schedule, the proportion disagreeing is not insignificant. Targeted education to improve paediatricians' knowledge of the chicken pox vaccine and their confidence discussing it should be implemented prior to the national roll out. • Many UK paediatricians pay for the chicken pox vaccine for their own children. • They commonly recommend the vaccine to family and friends when asked. • Paediatricians are receptive to further vaccine education in training and development. • Targeted resources and education are needed before a national introduction. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis is a rare complication of varicella‐zoster viral infection in adults, occurring due to a secondary bacterial infection. A 35‐year‐old female healthy patient had post‐varicella zoster infection with NSAID use as a possible risk factor. She was diagnosed early by clinical and laboratory parameters. [ABSTRACT FROM AUTHOR]