Herpes Zoster Causes and Treatments

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The Virus And The Host

The pathogenesis can in most cases be ascribed to degeneration and death of the infected cells. This may be mediated directly by the virus or by the immune clearance mechanisms. Denatured proteins elicit local inflammatory and systemic reactions. The local inflammatory response dominates the clinical picture in some infections, such as common colds, croup and bronchiolitis, while cell and organ failure or dysfunction is typical in poliomyelitis and hepatitis. Some infections are particularly dangerous to the fetus (CMV infection, rubella) or to the child in the perinatal period (herpes simplex, coxsackie B, varicella-zoster, hepatitis B and HIV infections). Bronchiolitis is seen only in the first 2 years of life, and croup mostly in children below school age. Otherwise the clinical course is not markedly different in children compared with adults.

Therapy And Prophylaxis

Some progress has been made in the development of antiviral drugs in recent years. Main obstacles to a rapid breakthrough seem to be the rather late appearance of symptoms in relation to tissue damage and the potential cytotoxic effect of inhibitors of virus replication. Examples of antiviral drugs which are used clinically are aciclovir and trifluorothymidine in herpes simplex and varicella-zoster virus infections, azidothymidine in HIV infection and interferon in chronic active hepatitis B and C. Amantadine has proved effective in the prophylaxis of influenza A. Antivirals are dealt with in Chapter 4. Immunoglobulins may provide short-term protection against certain virus infections. Normal human immunoglobulin is used in the prophylaxis of measles and hepatitis A, while specific immunoglobulins (produced from high-titred plasma) are needed for other infections (rabies, hepatitis B, varicella-zoster). A requirement for being effective is that the immunoglobulins are administered as...

Laboratory Diagnosis Of Virus Infections

Most virus infections run an asymptomatic course, or they are so mild that medical attention is not required. In many clinical cases an accurate aetiological diagnosis can be made solely on the basis of the clinical manifestations of the disease. Thus most cases of measles, varicella, zoster and mumps are diagnosed by the patient, his or her relatives, or by the family doctor. By contrast in other clinical situations, the resources required to establish an aetiological diagnosis are too great to justify virological examinations, for example in rhinovirus infections.

Laboratory Diagnosis

Antibody examinations are mostly performed with serum. Anticoagulants added to whole blood may interfere with complement activity and enzyme functions, and should be avoided. In certain situations (SSPE, herpes simplex encephalitis) antibody titration is performed on cerebrospinal fluid. Acute infection is diagnosed by demonstrating a rise in titre, seroconversion or specific IgM (or IgA). A rise in titre may be seen both in primary infections and in reinfection or after reactivation. A positive IgM test usually indicates a primary infection, but lower concentrations of specific IgM are found in reactivations (CMV infections and zoster) and reinfections (rubella). A variety of methods (complement fixation (CF), haemagglutination inhibition (HI), enzyme-linked immunosorbent assay (ELISA), immunofluorescence (IF)) are

The Nature Of Virus Reservoirs

A significant number of human viruses leading to either mild or life-threatening disease are maintained in human populations. The list runs the gamut from colds caused mainly by rhi-noviruses, warts caused by papillomaviruses, to AIDS caused by HIV. The mode of passage of viruses between humans (i.e., the vector) is intimately involved with human behavior. This behavior can be modified by the disease symptoms themselves. Thus, a respiratory infection leads to coughing and sneezing, which spreads an aerosol of droplets containing virus. HSV is spread in saliva requiring direct transfer of an aqueous suspension by contrast, the closely related varicella zoster (chicken pox) virus (VZV) is spread by inhalation of a virus-loaded aerosol. Warts are spread by direct physical contact between the virus-loaded source (another wart or a passive reservoir) and layers of the skin below the keratinized epidermis exposed by small cuts or abrasions. Poliovirus is spread only by virus-containing...

Persistent viral infections

Reactivation requires active participation of the host. Immunity, which normally shields the body against reinfection, must temporarily decline. Such a decline can be triggered by the host's reaction to physical or psychological stress. HSV reactivation often correlates with a host stressed by fatigue or anxiety. VZV reactivation leads to shingles, a very painful recrudescence throughout the sensory nerve net serving the site of the latent virus. Unlike HSV reactivation, VZV reactivation results in destruction of the nerve ganglion and is associated with a generalized decline in immunity associated with aging.

B cells and antibodymediated immune responses in chronic neuroinflammation

Persistent intrathecal immunoglobulin (Ig) synthesis is a key feature in the CSF of the majority of MS patients (Thompson et al., 1979) and contributes to diagnostic decision making. In fact, two distinct CSF parameters are important in the context of MS the oligoclonal bands (OCB) and the Measles Rubella Herpes Zoster (MRZ) reaction. The OCB represent a distinct pattern of Ig in the CSF which cannot be found in the peripheral blood. They have a high sensitivity, being detectable in around 90 of MS patients. However, their presence is not restricted to MS, as they can be found transiently in many inflammatory CNS conditions as the expression of a humoral host response. For instance, Herpes simplex virus (HSV)-specific Ig can be detected in the CSF of patients suffering from HSV encephalitis, with the majority of antibodies directed against the pathogen (Vandvik et al., 1982). By contrast, OCB in MS have failed to display a predominant specificity inter- and intraindividually, as they...

Acyclic or Carbocyclic Nucleoside Analogues

Acyclovir and valaciclovir (Fig. 1) are used in the treatment of mucosal, cutaneous and systemic HSV-1 and HSV-2 infections (including herpetic keratitis, herpetic encephalitis, genital herpes, neonatal herpes, and herpes labialis), and VZV infections (including varicella and herpes zoster). Acyclovir is administered orally at doses of 1 g (5 x 200mg) per day for genital herpes, up to 4 g (5 x 800mg) per day for herpes zoster or topically as a 3 ophthalmic cream for herpetic keratitis or 5 cream for herpes labialis or intravenously at 30mg kg (3 x 10mg kg) per day for herpetic encephalitis or other severe infections with herpesviruses. Valaciclovir is administered orally at 1 g (2 x 500mg) per day for genital herpes and up to 3 g (3 x 1g) per day for herpes zoster. Penciclovir (Fig. 1) can be used topically (as a 1 cream) in the treatment of superficial mucocutaneous HSV infections. Its prodrug famciclovir (Fig. 1) is administered orally at 750mg (3 x 250mg) or 1,500mg (3 x 500mg) per...

Congenital varicella syndrome CVS A

Severe disease of the fetus resulting from maternal infection with Human her-pesvirus 3 during the first two trimesters of pregnancy. Clinical manifestations range from multisystem involvement resulting in death in the neonatal period to dermatomal skin scarring, limb hypoplasia, or both as the only defects. The disease is rare and the overall risk of zoster in infancy following maternal varicella infection in the second and third trimesters of pregnancy is about 2 .

Infections And Their Management

Antivirals are generally targeted at a single virus or closely related viruses, rather than a large group of viruses. Amantadine acts well against influenza A virus but has no activity against influenza B virus, and aciclovir is useful against HSV and varicella zoster virus (VZV), but is not effective as treatment for cytomegalovirus (CMV) or Epstein-Barr virus infections, despite these being members of the herpes virus family. There are two available antivirals that could reasonably be described as broad-spectrum ribavirin (Snell, 2001) and cidofovir (Safrin et al., 1997). However, as their use is limited in many situations by uncertain in vivo efficacy and, for the latter especially, a poor safety profile, it is not possible to treat a presumed viral infection empirically.

Limit antiviral use where possible

In the majority of patients most viral infections do not require treatment. This will limit adverse effects and selection of resistant virus. For example, although aciclovir is an effective treatment for primary varicella zoster infection (chickenpox), there is little benefit in treating children with uncomplicated infection, as the illness is generally self-limiting with serious complications being rare (Tarlow and Walters, 1998). Similarly, although the drug pleconaril has recently been shown to reduce the severity of rhinovirus infections (Hayden et al., 2003), its use is not currently indicated in upper respiratory tract infections in otherwise healthy patients. It is also important not to use antivirals in situations where they have been shown not to be of benefit. Thus, although aciclovir can inhibit Epstein-Barr virus replication in vitro, it has not been shown to be effective in cases of glandular fever, probably due to the immune-mediated nature of the illness (van der Horst...

Correct timing of treatment

It is important to start treatment at the optimum time. For acute infections, most antivirals are only effective if commenced rapidly. In adults with primary varicella zoster, treatment is normally only recommended if it can commence within 24 hr of rash onset, or within 36-48 hr of symptom onset in influenza virus infection, as there is little evidence of efficacy beyond this point (Couch, 2000 Wilkins et al., 1998) and viral replication has usually peaked. This requires systems to be in place to see, diagnose, and treat such patients quickly. In many situations treatment may need to be started on a clinical basis unless very rapid PCR (or direct immunofluorescence) results can be obtained. Unnecessary treatment can be discontinued if the original diagnosis is not confirmed. In the case of recurrences of genital herpes, patients are often provided with antivirals in advance so that they can commence treatment at the first sign of symptoms (Drake et al., 2000).

Alternatives to antiviral prophylaxis

Vaccines, where available, are the preferred method for viral prophylaxis pre-exposure and often also post-exposure, for example, the hepatitis B vaccine and influenza vaccines (Department of Health, 1996). Vaccine, or a course of vaccine, need usually only be given once in a lifetime or, in the case of influenza, yearly. They generally have minimal side effects and no further action is required if contact does occur. Antiviral prophylaxis may still be required in some circumstances where a vaccine is available, such as where vaccine is contraindicated or response to vaccination is poor, as in the immuno-compromised. Passive vaccination with immunoglobulin may be another option after contact. For example, varicella zoster immunoglobulin is available after


VZV persists in a latent form in sensory nerve cells (dorsal roots of the spinal medulla or cranial nerve ganglia) for decades after varicella infection. Though re-exposure to VZV may be a factor in reactivation of virus in some circumstances, it is generally poorly understood why VZV starts replicating and spreading down sensory nerve fibres. VZV appears in vesicles on the skin area corresponding to the dermatome innervated by the nerve in question. Although zoster is less contagious than varicella, it may cause varicella in susceptible contacts.

Nucleotide phosphohydrolase An enzyme

Oka vaccine virus An attenuated Japanese strain of varicella-zoster virus, the basis of a licensed vaccine against chickenpox (Varivax ), which appears to provide long-term cell-mediated and humoral immunity, although breakthrough infections after exposure to wild-type VZV are occasionally seen in vaccinees. The vaccine has also been shown to cause herpes zoster in up to 6 of immunocompro-mised vaccinees, such as children with leukemia. After more than 20 years experience with the vaccine in Japan, it was licensed and recommended for use in the US in 1995. The genome DNAs of Oka vaccine and wild-type virus can be readily distinguished by a PCR-based test.

Oligoadenylate synthetase 25OAS

Opportunistic pathogens A variety of infectious pathogens, including many viruses, cause opportunistic infections in immunosuppressed persons. Amongst the viruses, those that are normally latent, such as cytomegalovirus, herpes simplex virus, JC polyoma virus and varicella-zoster virus, cause most common problems, especially in AIDS patients.

Molecular Detection Methods

Screening of three to five viruses or bacteria in one assay. These multiplex PCR assays include PCR amplification of T pallidum, H. ducreyi, HSV-1, and HSV-2 (Orle et al., 1996) PCR amplification of HSV-1, HSV-2, varicella-zoster virus (VZV), and enteroviruses (Read and Kurtz, 1999) PCR amplification of HSV-1, HSV-2, VZV, human cytomegalovirus (CMV), and Epstein-Barr virus (EBV) (Ryncarz et al., 1999 Markoulatos et al., 2001) and multiplex herpesvirus PCR assay on CMV, EBV, VZV, HSV, and human herpesvirus 6 (HHV-6) (Quereda et al., 2000). In addition, real-time quantification PCR assays (SYBR Green I and FRET probe-based) for HSV have also been established (Espy et al., 2000 Aldea et al., 2002). These assays provide sensitive and rapid laboratory diagnostic methods for HSV that can minimize the effects of contamination of sample by eliminating post-PCR processing steps. Recently, parallel detection of five human herpesviruses (CMV, EBV, HSV-1, HSV-2, and VZV) in a single run...

Clinical features

Clinically, patients present with localized or generalized erythematous papules, plaques or tumours 1-3 . Peculiar clinical presentations include the so-called 'facies leonina' and the onset of specific skin lesions at sites of previous herpes simplex or herpes zoster eruptions (Figs 14.1 & 14.2) 4 . These latter were often classified in the past as pseudolym-phoma 5,6 , but are in fact specific cutaneous manifestations of the disease 4,7 . It has been recently demonstrated that lesions arising at typical sites of Borrelia burgdorferi infection (nipple, scrotum, earlobe) represent specific manifestations of B-CLL triggered by infection with B. burgdorferi (Fig. 14.3) 8 . Lesions arising on the nipple were well known in the past and were termed 'leukaemia lymphatica mamillae' in old textbooks.

Drug discovery opportunities

And 70 of lipopolysaccharide-inducible genes have been shown to be JMJD3 targets 66 . Invading viral pathogens that depend upon the host cell's transcriptional machinery are also subject to the regulatory impact of histone modifications, and this has been specifically demonstrated for LSD1 where depletion or inhibition of its activity with MAOIs resulted in blockade of herpes simplex virus and varicella zoster virus gene expression 67 .

Shine Dalgarno sequence See ribosome binding site

Shingles A painful local condition with rash in the region (dermatome) served by one nerve root. May follow exposure to Human herpesvirus 3 (varicella-zoster virus), but usually occurs as a reactivation of latent infection, especially in patients who are immunocompromised. Synonym zona zoster.

Infections of Neonates and Human Products of Conception

Suspected infections acquired by the fetus as a result of a maternal infection that crosses the placenta (congenital infection) can be diagnosed culturally or serologically in the newborn. Because maternal IgG crosses the placenta, serologic tests are often difficult to interpret (see Chapter 10). For culturable agents, the most definitive diagnoses involve recovery of the pathogen in culture. HSV, varicella-zoster virus (VZV), enteroviruses, and cytomegalovirus (CMV) can be cultured easily, as can most bacterial agents. Rubella and parvovirus B19 are more difficult to culture. Nasal and urine specimens offer the greatest yield for viral isolation, whereas blood, cerebrospinal fluid, and material from a lesion can also be productive. Systemic neonatal herpes without lesions may be difficult to diagnose unless tissue biopsy material is examined, because the viruses may not be present in cerebrospinal fluid or blood. Bacteria and fungi can be isolated from lesions, blood, and other...

CD30 Tcell pseudolymphomas

In recent years, the presence of CD30+ large blasts has been observed in the skin in several reactive conditions including various viral infections (orf, milker's nodule, molluscum con-tagiosum, viral warts, herpes simplex, herpes zoster), arthropod reactions, scabies and drug eruptions (Figs 20.16-20.19) 52-56 . CD30+ cells have also been observed in lesions of hidradenitis and rhynophyma, as well as at the sites of cutaneous abscess and of injury caused by red sea coral. The finding may be related, at least in part, to improved methods

Structure of the Hair and Follicle

In cross section, a hair reveals three layers (1) the medulla, a core of loosely arranged cells and air spaces (2) the cortex, composed of densely packed keratinized cells and (3) the cuticle, a single layer of scaly cells that overlap each other like roof shingles, with their free edges directed upward (fig. 6.8c). Cells lining the follicle are like shingles facing in the opposite direction. They interlock with the scales of the hair cuticle and resist pulling on the hair. When a hair is pulled out, this layer of follicle cells comes with it.

Isoelectric Focusing of the CSF

Polyspecific Response Associated with CNS Autoimmune Diseases. The oligoclonal, intrathecally synthesized IgG contains numerous specific antibodies and autoantibodies. Antibodies are frequently found with specificities against measles, the rubella virus and the varicella-zoster virus, but seldom against the herpes simplex virus. The occurrence of one, two, or three of these antibodies is referred to as the MRZ reaction. The corresponding antigens are not present in these cases. The MRZ reaction is typical of multiple sclerosis as well as cerebral lupus erythematosus and is a chronically evolving immune process (F5, K10, S16).

Human endogenous retroviruses HERV

Human herpesvirus 3 (HHV-3) Type species of the genus Varicellovirus, in the subfamily Alphaherpesvirinae. The genome DNA has been completely sequenced for the Dumas strain, and is 125kb in length, with a G+C of 46 . It consists of an L and an S component bounded by repeats. The S component can be inverted to form two isomers, and both are present in packaged genome DNA. The cause of common human infection. Causes chick-enpox on primary infection, usually in childhood. Incubation period 1-16 days, rarely up to 21 days. Causes herpes zoster, a painful local condition with skin lesions, usually in adults. The eyes may be involved. May follow exposure to infection but most commonly appears as a reactivation of latent infection. Encephalitis is a rare complication of chickenpox. Fetal malformations have been reported to follow maternal infection. All strains are antigenically similar. Convalescent serum has no therapeutic use but an attenuated vaccine developed in Japan (the Oka strain)...

Methods Of Antibody Detection

Widal Test Slide Method

Complete systems for the use of latex or other particle agglutination tests are available commercially for the accurate and sensitive detection of antibody to cytomegalovirus, rubella virus, varicella-zoster virus, the heterophile antibody of infectious mononucleosis, teidioic acid antibodies of staphylococci, antistrepto-coccal antibodies, mycoplasma antibodies, and others. Latex tests for antibodies to Coccidioides, Sporothrix, Echinococcus, and Trichinella are available, although they are not widely used because of the uncommon occurrence of the corresponding infection or its limited geographic distribution. Use of tests for Candida antibodies has not yet shown results reliable enough for accurate diagnosis of disease.

Perinatal Infection

Cocci Lesions

The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or perinatal infection with herpes simplex virus, Toxoplasma gondii and varicella-zoster virus occurs in about 1 per 1,000 live births and the sequelae may be severe. In-utero acquired infection may result in resorption of the embryo, abortion, stillbirth, malformation, intrauterine growth retardation, prematurity, and the numerous untoward sequelae associated with chronic infection. Infection acquired at or soon after birth may lead to death or persistent postnatal infection. Some infections may be...

Molecular Detection of Drug Resistance

The detection of viral mutations associated with drug resistance has been well documented. Examples include polymerase and protease inhibitors with human immunodeficiency virus (HIV), acyclovir and penciclovir resistance in herpes simplex virus, acyclovir resistance in varicella-zoster virus, ganciclovir resistance in cytomegalovirus, famciclovir and lamivudune resistance with hepatitis B virus, and amantidine resistance with influenza A (Shafer and Chou, 2003). Viral mutations are most commonly detected by direct sequencing of the specific viral reading frames, which encode the proteins that are targeted by currently available antiviral drugs. Genotypic resistance testing to mange HIV-1-infected patients is widely used by physicians.

Immunofluorescent Assays

Direct Immunofluorescence Digramof

Fluorescent antibody tests are commonly used to detect Bordetella pertussis, Legionella pneumophila, Giardia, Cryptosporidium, Pneumocystis, Trichomonas, herpes simplex virus, cytomegalovirus, varicella-zoster virus, RSV, adenovirus, influenza virus, and parainfluenza virus in clinical specimens.

Definite Respiratory Tract Pathogens

Viruses (respiratory syncytial virus, human metapneumovirus, adenoviruses, enteroviruses, Hantavirus, herpes simplex virus, influenza and parainfluenza virus, rhinoviruses, severe acute respiratory syndrome) RARE RESPIRATORY TRACT PATHOGENS Francisella tularensis Bacillus anthracis Yersinia pestis Burkhoideria pseudomallei Coxiella bumetti Chlamydophila psittaei Brucella spp. Salmonella spp. Pasteurella multocida Klebsiella rhinoscleromatis Varicella-zoster virus (VZV) Parasites

Degeneration And Aggregation Of Vzv

Suppression, VZV reactivates to cause zoster. Zoster is a modified or limited form of varicella, localized to a specific dermatome, the cutaneous area served by the infected nerve ganglion. Virus is present in the vesicular fluid and in the cells at the base of the vesicle. Material for virus detection should be collected from newly formed vesicles. Once the vesicle has opened and crusted over, detection is unlikely. Virus can be detected by staining cells from the base of the vesicles, by culturing cells and vesicular fluid, or by PCR testing of fluid and cells. The Tzank test, which is a smear of cells from the base of the vesicle stained by the Giemsa, Papanicolaou (Pap), or other suitable cytologic staining method, detects typical multinucleated giant cells and inclusions (Figure 51-14, A). The FA stain also can be used to detect VZV in Tzanck smears. Traditionally, diploid fibroblast cell culture (e.g., MRC-5) has been used to detect VZV, which requires up to 28 days before...

Other cutaneous pseudolymphomas

Previous paragraphs, the occurrence of other skin conditions simulating clinically and or histopathologically cutaneous lymphomas has been reported sporadically. Cases of inflammatory lesions of vitiligo and of eruption of lymphocyte recovery with histopathological features mimicking those of mycosis fungoides have been observed 99,100 . A condition termed 'annular lichenoid dermatitis of youth' has been reported recently as a simulator of mycosis fungoides, but it may in truth represent a variant of this disease in children 101 . Besides the entities listed in the paragraph on CD30+ cutaneous pseudolymphomas (see p. 163), we have rarely observed the presence of dense lymphoid infiltrates with scattered CD30+ cells in skin lesions of mycotic infections. True B-cell pseudolymphomas have been observed at the site of previous herpes zoster eruptions 102 . However, it must be stressed that only a few cases of clear-cut pseudolymphoma have been documented in association with herpes zoster...

Nonspecific methods of introducing viral genomes into cells

An example of the use of transfection to examine the properties of a viral protein is illustrated in Fig. 6.5. Here, cells were transfected with a fragment of DNA containing the gene for the varicella-zoster virus (herpes zoster virus) glycoprotein, gL. This gene is controlled by a promoter that can be expressed by transcriptional machinery of the uninfected cell (see Chapter 13). The three micrographs shown in Fig. 6.5(b) were taken just after, 12 hours after, and 24 hours after transfection. Cells were incubated with a fluorescent antibody against gL (see Chapter 12). The expression of this protein in the cytoplasm is quite evident at the later times.

Herpesvirus Replication And Latency The herpesviruses as a group

Many herpesviruses are neurotropic (i.e., they actively infect nervous tissue) all such viruses are collectively termed alpha-herpesviruses. Three human herpesviruses belong to this group the closely related herpes simplex virus types 1 and 2 (HSV-1 and -2), which are the primary agents of recurrent facial and genital herpetic lesions, respectively and varicella-zoster virus (VZV), which is the causative agent of chicken pox and shingles. VZV is more distantly related to HSV. Pseudorabies virus (herpesvirus suis), an important animal pathogen, which has many similarities with HSV is also an alpha-herpesvirus.

PCR See polymerase chain reaction

Penciclovir A drug related to acyclovir which is selectively phosphorylated by the HSV thymidine kinase and inhibits replication of herpesviruses such as VZV and CMV as well as HSV. It is licensed as a cream for use against oral herpes. Because it was not effective orally, the 6-deoxydiacetyl ester derivative famciclovir was developed as an orally delivered prodrug of penciclovir and is now licensed for treatment, especially of herpes zoster infections in immunosup-pressed patients. It is also effective against hepatitis B.

Why should I take drugs that have side effects

Infection Infections complicating the use of steroids include an increased risk of infection of all types, including viral, bacterial, fungal, and parasitic disease. Although viral infections are usually mentioned as a risk with steroid administration, including a risk of progressive multifocal leukoencephalopathy (PML), these infections are relatively uncommon. Shingles (herpes zoster) and flares of genital herpes are probably the most common viral infections seen. Shingles skin infection caused by the herpes zoster virus.

Prodrugs Of Nucleosides The Ribose Ring

The dominant prodrug strategy adopted on the ribose ring involves appending carboxyl groups, e.g. esters, carbonates and carbamates, to the ribose hydroxyl groups, in order to improve drug exposure and oral bioavailability. The prodrug can block unwanted metabolic pathways, increase log D, and improve permeability. Additionally, some prodrugs, e.g. amino acid esters, can take advantage of in vivo transporter systems. Peptidases, esterases and other hydrolases in the host catalyze the release of the parent molecule. The L-valine ester prodrug valaciclovir, 5, has a 3-5 fold improved oral bioavailability compared to acyclovir (aciclovir) 6 . This allows for a more convenient administration of acyclovir for treating herpes zoster (VZV) and genital herpes (HSV) 7 . Another group utilized an approach referred to as the 'trimethyl lock' on ganciclovir, analog 9, and reported a 4-fold increase in oral bioavailability 18 . Cleavage of the acetate ester is followed by intramolecular...

Erythema infectiosum fifth disease A

Human herpesvirus 1 and 2 cause keratoconjunctivitis. Varicellavirus in chickenpox, about 4 of cases have some corneal or conjunctival involvement in shingles, vesicles may occur on the cornea and result in scarring. In congenital cytomegalovirus infection

Immunochemical Methods Used chapter for Organism Detection

Certain factors can hinder the diagnosis of an infectious disease by culture and biochemical techniques. These factors include the inability to cultivate an organism on artificial media, such as with Treponema pallidum, the agent of syphilis, or the fragility of an organism and its subsequent failure to survive transport to the laboratory, such as with respiratory syncytial virus and varicella-zoster virus. The fastidious nature of some organisms, such as leptospira or Bartonella, can result in long incubation periods before growth is evident, or administration of antimicrobial therapy before a specimen is obtained, such as with a patient who has received partial treatment, also can impede diagnosis. In these cases, detecting a specific product of the infectious agent in clinical specimens is very important because this product would not be present in the specimen in the absence of the agent. This chapter discusses the direct detection of microorganisms in patient specimens using...

Symptoms And Signs

The Herpes 2 infection usually affects the genital regions. The primary genital infection may be severe, with illness usually lasting up to about 3 weeks (sometimes longer) with a shedding period of virus usually terminating shortly before or at the time of healing. The lesions are vesicles or ulcers localized to the cervix, vagina, vulva or perineum of the female, or the penis in the male. The lesions are painful, and may be associated with inguinal lymphadenopathy and dysuria. Systemic complaints, including fever and malaise, usually occur. Complicating extragenital affections, including aseptic meningitis, have been observed in about 10-20 of cases. Paraesthesia or dysesthesia may occur after the genital affection. Especially in women the severity of the primary infection may be associated with a high number of complications and frequent recurrences. Previous HSV1 infection reduces the severity and duration of primary HSV2 infection. The recurrent genital affection is usually...

Real Time PCR in Infectious Disease Diagnosis

Quantitative measurement of viral load using real-time PCR is another significant methodology improvement, and its diagnostic implication is infinite. First of all, HIV viral copy numbers in blood and body fluids are important disease and treatment markers directly tied into actions of clinical management. RNA reverse transcription and PCR (RT-PCR) can be established in a single-tube reaction, and copy numbers can be extrapolated from a standard curve in a single run (Kostrikis, 2002 Erikkson, 2003 Lee, 2004 Watzinger, 2004). Similarly, other viral etiology such as cytomegalovirus (CMV Jebbink, 2003), HSV-1, HSV-2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV Legoff, 2004), parvovirus B19 (Hokynar, 2004 Plentz, 2004 Liefeldt, 2005), human polyomaviruses of BK and JC, and human herpesviruses 6,7, and 8 can be measured both qualitatively and quantitatively according to clinical needs (Whiley, 2001 Beck, 2004 Watzinger, 2004). RT-PCR can be performed to detect and quantify...


Respiratory virus screening by use of pooled antibodies can test for 7 viruses in a single cell spot (Landry and Ferguson, 2000b). Because the same symptoms can be caused by many viruses, this provides an advantage similar to culture. Likewise, antibodies to herpes simplex virus (HSV) and varicella-zoster virus (VZV) can be pooled to screen skin lesions (Scicchitano et al., 1999).

The Target Viruses

By mutation and selection, evade the blocking effects of a single inhibitor. Therefore, as with tuberculosis, the practical answer is to find inhibitors of a wide range of virus-specific enzymes or proteins and to use them in a patient simultaneously. This search for new drugs will be a continuing need as it is with antibacterials. Similarly, inhibitors of pandemic and epidemic influenza A viruses will need the continuing attention of antiviral chemotherapists. The human herpes viruses (HHV1-8) cause a remarkably diverse range of important diseases and will continue to remain important targets, especially VZV (varicella-zoster virus or shingles), which will reach new importance in a world population with increasing longevity. Common cold viruses and other viruses of the respiratory tract cause pathogenesis in the upper respiratory tract during all months of the year in all countries of the world and hence have economic importance. The eight or so hepatitis viruses, and especially...


People infected with HIV may experience a flulike illness within a month or two of exposure to the virus many have no symptoms. This symptom-free period lasts from a few months to a decade, although the virus is actively multiplying, infecting, and killing immune system cells during this time. The only sign of this virulent activity may be a decline in blood levels of CD4 cells from a normal level of about 1,000. Once a person's CD4-cell count falls below 200, he or she is considered to have AIDS. By that time, other signs of the immune system's deterioration have appeared swollen glands, lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections, skin rashes, short-term memory loss, frequent and severe herpes infections, or a painful nerve disease called shingles.

Viral Conjunctivitis

Viral conjunctivitis usually has an acute onset, is unilateral, and lasts 1 wk, but it frequently becomes bilateral. A major clinical symptom that differentiates this from AC is burning and the absence of itching. Adenoviral infections are among the most common viral ocular infections and are extremely contagious. The viral infection produces an inferior follicular response and a serous discharge. It may also involve the cornea as a punctate keratopathy or superficial ulcerations (herpes simplex or herpes zoster infections).

Do viruses cause MS

The herpes families of viruses are DNA viruses that once inside our bodies persist for the rest of our lives. Although herpes simplex type I (HSV-1) and type II (HSV-2) can live in neurons and seem to be protected by them, there is no evidence that they or another family of herpes viruses (cytomegaloviruses) have any potential role in the causation or reactivation of MS. Although another herpes virus (the chickenpox or zoster virus) can cause demyelination in rare circumstances, this virus has no demonstrated role in MS. In the last few years, attention has turned to other herpes viruses, specifically the Epstein-Barr virus (EBV) and herpes simplex virus 6 (HSV-6). several species (types) of Herpes virus are responsible for diseases including chickenpox, shingles, mononucleosis, (fever blisters or cold sores and roseola infantum.


RFLP analysis has found widespread application in clinical microbiology. It has been used to differentiate between HSV type I and HSV type II (Rogers et al., 1991 Podzorski et al., 2000). In this case, HSV-specific primers (Rogers et al., 1991) target a 476-bp region of HSV polymerase gene. The PCR product from HSV I and HSV II differ in that HSV I contains two AvaII restriction sites in the amplified region, and HSV II contains one AvaII site in this stretch. After AvaII restriction digestion of the PCR product, agarose gel electrophoresis demonstrates three bands (87, 183, and 296 bp) from the HSV I product, while two bands (87 bp and 389 bp) result from HSV II. Mutations in cytomegalovirus (CMV) genes, including the UL97 protein kinase gene, the UL64 DNA polymerase gene, and the UL54 polymerase gene have been associated with resistance to ganciclovir, cidofovir, and foscarnet (Rogers et al., 1991 Prix et al., 1999 Emery, 2001). The latter mutations have all been targeted and...

Helicase Inhibitors

The herpes simplex virus genome expresses two helicases during its replication cycle, encoded by the viral genes UL5 and UL9. The former is found in a protein complex that also contains the primase protein (coded by UL52). As reported in 2002 (Crute et al. 2002 Kleymann et al. 2002), both Boehringer Biomega and Bayer developed highly specific inhibitors of the helicase-primase complex, and it is hoped that clinical trials will reflect the excellent in vitro activity and the in vivo efficacy already observed in several animal models of herpesvirus disease. More recently, Phase 2 studies with ASP2151, an inhibitor of the Herpes Virus helicase-primase that is under development by Astellas Pharma, have been initiated in patients with herpes zoster and genital herpes, in Japan and the USA (see info astellas.com).

Infectious Etiology

Infection can predispose to stroke, either through systemic effects of inflammatory mediators that cause a relatively prothrombotic state or by direct or indirect effects on blood vessels through a variety of mechanisms (76). In children, ischemic stroke is a known complication of infectious endocarditis that leads to cardioembolic stroke, and of meningitis with a local vasculitis as blood vessels course through an inflamed subarachnoid space (77). The importance of chicken pox as a risk factor for childhood stroke has been suggested by recent data. Varicella zoster may damage blood vessels directly by actual invasion of the vessels and is thought to cause a transient cerebral arteriopathy in children (78,79). A small case-control study found that children with stroke are almost 18 times more likely to have had chicken pox in the 9 months prior to stroke ictus compared to healthy control children (80). Chorioamnionitis is a risk factor for neonatal stroke the placental pathology...


Genital herpes Genital herpes is a contagious viral infection primarily affecting the genitals of men and women. It is characterized by recurrent clusters of vesicles and lesions in the affected areas and is caused by the herpes simplex-2 virus (HSV-2). This virus is one of several species of the herpes virus responsible for chick-enpox, shingles, mononucleosis, and oral herpes (fever blisters or cold sores, HSV-1). Infections have reached epidemic proportions with 500,000 diagnosed each year in the U.S. One in five American adults has genital herpes. including chickenpox, shingles, mononucleosis, oral herpes (fever blisters or cold sores, HSV-1) and roseola infantum. These are DNA viruses. Shingles Skin infection caused by the herpes zoster virus. They are typically associated with pain.


(HSV-1), keratitis (HSV-1), herpetic whitlow (HSV-1 and -2), encephalitis (HSV-1 in adults), disseminated disease (HSV-1 or HSV-2 in neonates) Detection 'cell culture (HDF, others), EIA, FA stain, PCR Treatment Acyclovir Prevention Avoid contact Virus Varicella-zoster virus (VZV) Transmission Close personal contact, especially respiratory Site of latency Dorsal root ganglia Disease Chicken pox (varicella), shingles (zoster) Detection FA stain, cell culture (HDF), shell vial culture, PCR Treatment Acyclovir and famciclovir Prevention Vaccine Vims Epstein-Barr virus (EBV) Transmission Close contact with infected saliva Site of latency B lymphocytes Kaposi's sarcoma-associated herpes virus (KSHV). HHV-6 and HHV-7 are associated with the childhood disease roseola (exanthem subitum), characterized by short-lasting fever and skin rash. HHV-8 is the primary and necessary factor for development of Kaposi's sarcoma. Herpes viruses are prototypical latent DNA viruses, with the lifelong...


Viral causes of endophthalmitis include HSV, varicella (herpes) zoster virus (VZV), cytomegalovirus, and measles viruses. The most common parasitic cause is Toxocara. Toxoplasma gondii is a well-known cause of chorioretinitis. Thirteen percent of patients with cysti-cercosis have ocular involvement. Onchocerca usually produces keratitis, but intraocular infection also occurs.

Viral Esophagitis

Other rare viral causes of bleeding esophageal lesions include varicella zoster virus, human papillomavirus, and human immunodeficiency virus (HIV) (Fig. 3) (54,55). There are reports of isolation of HIV from esophageal ulcers in infected patients (56), suggesting a pathologic role of the virus. However, the role of HIV in the development of esophageal ulceration is still unclear, as the presence of HIV in the esophageal mucosa is common and often is independent of esophageal pathology (55,57).

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