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Skin Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Christopher Bunker, Richard Watchorn
Varicella zoster virus (VZV) is discussed in Chapter 3, Infectious disease (Figure 18.39; Figure 18.40).
Skin, soft tissue and bone infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Varicella zoster virus is spread by respiratory droplets or direct contact with vesicles; incubation is 10–21 days. Herpes simplex virus is spread by direct contact including sexual transmission; it enters through skin breaks or the mucosal surface; incubation is 2–12 days. Both can spread from mother to baby in the perinatal period. Those at risk of complications of HSV and VZV include immunocompromised patients, pregnant women, children and elderly people.
Diagnostic Approach to Fulminant Hepatitis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Varicella-zoster virus (VZV) is a herpesvirus well-known to be contagious in childhood; it can affect both immunosuppressed and immunocompetent adults. The predisposition of immunosuppressed adults, especially post organ transplant or HIV patients, to contract VZV infection and develop ALF is well-known [26]. These patients have a high incidence of other visceral involvement, such as pneumonitis and meningoencephalitis. The VZV infection begins with a vague abdominal or back pain, followed by fever, cutaneous rash, acute hepatitis, and coagulation impairment, leading to disseminated intravascular coagulation and gastrointestinal hemorrhage. The rash of VZV begins as erythematous papules that may precede, coincide with, or follow the onset of hepatitis, making the diagnosis of this complication difficult [26] Diagnosis can be made via viral culture, the presence of detectable VZV DNA by PCR in the serum, or direct immunofluorescence on liver biopsy. Serologic testing is generally not helpful to diagnose VZV in ALF but can be used to determine susceptibility and the need for immunization [27]. Treatment of VZV hepatitis is intravenous acyclovir.
Repeated vaccination and ‘vaccine exhaustion’: relevance to the COVID-19 crisis
Published in Expert Review of Vaccines, 2022
Md Anwarul Azim Majumder, Mohammed S. Razzaque
Resistance associated with prophylactic use of the vaccine is less likely than the commonly encountered drug resistance [39]. There is also evidence showing that despite microbial evolution, the original vaccine can still be able to exert the necessary protection. The recombinant Varicella zoster vaccine is generated against the viral glycoprotein E as an antigen that provides protection to all genotypes; surprisingly, vaccine effectiveness was not compromised with subsequent viral mutations. Of relevance, Varicella zoster virus infection is higher among elderly individuals, immunocompromised patients, and transplant patients [40]. Similarly, the genotype-specific recombinant L1 protein is used to generate a human papillomavirus vaccine; however, viral mutations affecting L1 protein did not significantly reduce the vaccine effectiveness [41,42].
Efficacy and safety of rituximab in autoimmune pancreatitis type 1: our experiences and systematic review of the literature
Published in Scandinavian Journal of Gastroenterology, 2021
Sara Nikolic, Nikola Panic, Elina Sofia Hintikka, Lara Dani, Wiktor Rutkowski, Aleksandra Hedström, Corinna Steiner, J.-Matthias Löhr, Miroslav Vujasinovic
Concerning adverse events in the eight selected studies, the above-mentioned infusion reactions and infections were the main adverse events. The prevalence of infections was from 0–33% in selected studies [3,10,19,20,24]. Common infections were pneumonia, urinary tract sepsis, clostridium difficile colitis, dental abscess and sinusitis [24]. Of severe infections, one patient each suffered from recurrent urinary and biliary sepsis with Gram-negative and Staphylococcus aureus bacteremia, recurrent anal abscesses, Staphylococcus hominis mitral endocarditis and recurrent angiocholitis with Gram-negative bacteremia during biliary relapses [20], diverticulitis and severe neutropenia needing treatment with granulocyte colony-stimulating factor [24]. Concerning infections, varicella-zoster virus was observed in two patients [19,21]. One patient with highly aggressive IgG4-RD was given RTX and high-dose steroid pulse as a last resort and later died due to acute cholangiosepsis and pneumonia with multi-organ failure [19,21]. Other side effects described were hemolytic anemia, amaurosis fugax, leading to carotid endarterectomy, unstable angina and surgery for an IgG4-related orbital pseudotumor [23].
Varicella-zoster virus causing a ring-like cerebral lesion in AIDS
Published in Baylor University Medical Center Proceedings, 2020
Jennifer Nielsen Fan, Robyn R. Fader, MaryAnn P. Tran, Christie Ann Shen
Varicella-zoster virus causes chickenpox as a primary infection, subsequently becomes latent in the dorsal root ganglia for up to decades, and may reactivate and cause a painful vesicular rash in a classic dermatomal distribution. Reactivation often follows a stressful trigger or immunocompromised state. Well-known complications of varicella-zoster virus reactivation include encephalitis, motor weakness or myelopathies, cranial nerve neuropathies, zoster sine herpete, Guillain-Barre syndrome, and, most significantly, vasculitis.1 It has been estimated that only 0.4% of identified viral encephalopathies are due to varicella zoster in the United States, and 7.7% of patients hospitalized for an encephalitis presented with comorbid human immunodeficiency virus (HIV) infection.2 We report a unique case of an encephalopathic patient undergoing workup for a stroke, whose repeat brain magnetic resonance imaging (MRI) showed a ring-enhancing lesion determined to be caused by varicella-zoster virus vasculitis in the setting of a newly acquired immune deficiency syndrome.