1/29. Persistent verrucous varicella as the initial manifestation of hiv infection.Clinical presentations of varicella-zoster virus (VZV) infection may vary widely among healthy and immunocompromised patients. In addition, the recurrence of VZV infection with cutaneous manifestations in both of these populations is more common than was once believed. Most cases of verrucous varicella infection have been reported in patients with documented immunosuppression (most commonly hiv/AIDS). We present an unusual case of persistent verrucous varicella, which was the initial manifestation of hiv infection, in a previously "healthy" 3-year-old girl with a strong family history of wiskott-aldrich syndrome. Current research, therapeutic options, and differential diagnoses with regard to VZV infection are briefly reviewed.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/29. Chronic graft-versus-host disease after hematopoietic cell transplantation presenting as an acute hepatitis.A variety of illnesses involving the gut and liver follow hematopoietic cell transplantation (HCT). A 20 yr-old white male developed severe acute hepatitis 36 wk (day 252) after matched, unrelated, allogeneic HCT for chronic myelogenous leukemia (CML). Mild skin graft-versus-host disease (GVHD) had occurred at about 20 wk (day 140) after transplant. liver biopsy showed bile duct injury and a diffuse lobular injury pattern most consistent with a GVHD variant and not reminiscent of drug-induced or viral hepatitis. No findings suggestive of herpesvirus, adenovirus, or varicella-zoster virus were found. High-dose steroids resulted in marked improvement of his liver enzyme levels. We report this patient as representing the acute hepatitic presentation of chronic GVHD of the liver.- - - - - - - - - - ranking = 0.14285714285714keywords = varicella (Clic here for more details about this article) |
3/29. Prolonged herpes zoster in a patient infected with the human immunodeficiency virus.In 1983, varicella zoster virus (VZV) disease was first recognized in the context of infection with the human immunodeficiency virus (hiv). Since that time, there have been many reports discussing the occurrence and clinical manifestations of hepes zoster in hiv-infected patients. We describe the development of prolonged herpes zoster in a patient with acquired immunodeficiency syndrome (AIDS) over the course of 104 days. Viral isolates at the three different clinical stages of the skin lesions were sensitive in vitro to acyclovir, and supposed to be a same strain by polymerase chain reaction (PCR) analysis. We also discuss an effective treatment for prolonged cases of zoster.- - - - - - - - - - ranking = 0.14285714285714keywords = varicella (Clic here for more details about this article) |
4/29. Group A streptococcal osteomyelitis: severe presentation and course.AIM: To evaluate the course of group A streptococcal osteomyelitis associated with severe disease nowadays. methods: Three consecutive cases of severe group A streptococcal disease with osteomyelitis in children that were documented in beer Sheva, israel are described in detail. RESULTS: Two of the three cases were postvaricella. Early in the course of the disease, the presentation resembled that of severe cellulitis. All three patients had severe osteomyelitis and required surgery, and one patient developed chronic osteomyelitis. sepsis was diagnosed in two cases. CONCLUSION: Our cases are distinguishable from typical haematogenous staphylococcal osteomyelitis by the severe course and the extensive involvement of bone and soft tissues. The increase in severity of invasive group A streptococcal infections documented throughout the world could account for the difference between our complex cases and the previous reports.- - - - - - - - - - ranking = 0.14285714285714keywords = varicella (Clic here for more details about this article) |
5/29. Chronic varicella-zoster virus ganglionitis--a possible cause of postherpetic neuralgia.Postherpetic neuralgia (PHN) is dermatomal distribution pain that persists for months to years after the resolution of herpes zoster rash. The cause of PHN is unknown. Herein, we report clinical, molecular virological, and immunological findings over an 11-year period in an immunocompetent elderly woman with PHN. Initially, blood mononuclear cells (MNCs) contained varicella-zoster virus (VZV) dna on two consecutive occasions. Random testing after treatment with famciclovir to relieve pain did not detect VZV dna. However, the patient was reluctant to continue famciclovir indefinitely and voluntarily stopped drug treatment five times. pain always recurred within 1 week, and blood MNCs contained many, but not all, regions of the VZV genome on all five occasions. Immunological analysis revealed increased cell-mediated immunity to VZV. Chronic VZV ganglionitis-induced PHN best explains the recurrence of VZV dna in MNCs whenever famciclovir was discontinued; the detection of only some regions of the viral genome in MNCs, compared to the detection of all regions of the VZV genome in latently infected ganglia; the increased cell-mediated immunity to VZV; and a gratifying clinical response to famciclovir. The presence of fragments of VZV dna in MNCs likely represents partial degradation of viral dna in MNCs that trafficked through ganglia during productive infection.- - - - - - - - - - ranking = 0.71428571428571keywords = varicella (Clic here for more details about this article) |
6/29. Chronic active VZV infection manifesting as zoster sine herpete, zoster paresis and myelopathy.After lumbar-distribution zoster, an HTLV-1-seropositive woman developed chronic radicular sacral-distribution pain (zoster sine herpete), cervical-distribution zoster paresis and thoracic-distribution myelopathy. Detection of anti-varicella zoster virus (VZV) IgM and VZV IgG antibody in cerebrospinal fluid (CSF), with reduced serum/CSF ratios of anti-VZV IgG compared to normal serum/CSF ratios for albumin and total IgG, proved that VZV caused the protracted neurological complications. diagnosis by antibody testing led to aggressive antiviral treatment and a favorable outcome.- - - - - - - - - - ranking = 0.14285714285714keywords = varicella (Clic here for more details about this article) |
7/29. Relapsing-remitting, corticosteroid-sensitive, varicella zoster virus optic neuritis.We report a 13-year-old male who presented with bilateral disc edema after a febrile illness. Rapid loss of vision prompted corticosteroids treatment, which reversed the visual loss and optic disc findings. Both his visual function and disc edema proved exceedingly sensitive to steroids, and he required increasingly slow and prolonged corticosteroids taper to avoid relapse over a period of 1 year. Ultimately, profound visual loss was reversed three times and only after exceptionally slow steroid weaning. Comprehensive systemic investigations and neuroimaging were initially unrevealing. Late in the course of disease, evidence of seroconversion was identified in his serum and cerebrospinal fluid with positive varicella zoster virus antibodies titers. Varicella zoster virus-related optic nerve pathology may present clinically with profound visual loss and disc edema and may reverse only with high-dose corticosteroids treatment. physicians should carefully consider retesting with late varicella zoster virus titer in patients with relapsing-remitting, steroid-sensitive optic neuritides.- - - - - - - - - - ranking = 0.85714285714286keywords = varicella (Clic here for more details about this article) |
8/29. Chronic graft-versus-host disease following varicella-zoster virus infection in allogeneic stem cell transplant recipients.We describe 2 allogeneic stem cell transplantation patients who developed chronic graft-versus-host disease (GVHD) after dermatomal varicella-zoster virus (VZV) infection. Localized zoster did not respond to oral valaciclovir but did resolve with intravenous aciclovir. However, skin eruptions, eye/oral dryness, and liver dysfunction were observed at the healing stage of localized zoster, suggesting development of GVHD. Intensification of immunosuppressive therapy was required to control GVHD. Quantitative real-time PCR for VZV dna was used to distinguish liver involvement by chronic GVHD from visceral dissemination of VZV in 1 patient. VZV infection may trigger chronic GVHD after allogeneic stem cell transplantation.- - - - - - - - - - ranking = 0.71428571428571keywords = varicella (Clic here for more details about this article) |
9/29. herpes simplex uveitis.BACKGROUND: uveitis in herpes simplex virus (HSV) ocular disease is usually associated with corneal stromal disease. It has generally been believed that herpetic uveitis in the absence of corneal disease is very rare. When seen it is usually attributed to varicella zoster virus (VZV) infections. The diagnosis of uveitis caused by herpes simplex is often not diagnosed resulting in inadequate treatment and a poor visual result. methods: Seven patients from a large uveitis practice who presented with a clinical picture of: anterior uveitis and sectoral iris atrophy without keratitis, a syndrome highly suggestive of herpetic infection, are reported. polymerase chain reaction (PCR) was done in the aqueous of four of them and was positive for HSV. One patient had bilateral disease. Most of the patients also had severe secondary glaucoma. RESULTS: Of the seven patients presented five had no history of any previous corneal disease. Two had a history of previous dendritic keratitis which was not active at the time of uveitis development. One patient with bilateral disease was immunosuppressed at the time when the uveitis developed. Six of the seven patients had elevated intraocular pressures at the time of uveitis and five required glaucoma surgery. Intractable glaucoma developed in two patients leading to rapid and severe visual loss despite aggressive management. CONCLUSION: Findings suggest that uveitis without corneal involvement may be a more frequent manifestation of ocular herpes simplex disease than previously thought. Absence of corneal involvement delays a correct diagnosis and may worsen visual outcome. Primary herpetic uveitis (when there is no history of previous corneal disease) seems to be more severe than the uveitis in patients with previous corneal recurrences. The associated glaucoma may be a devastating complication.- - - - - - - - - - ranking = 0.14285714285714keywords = varicella (Clic here for more details about this article) |
10/29. Concurrent verrucous and varicelliform rashes following renal transplantation.Verrucous rashes associated with varicella zoster virus (VZV) infection are well recognized in hiv infection. Seen rarely in transplant patients, no histologically confirmed case has been published in the transplant setting. We now report chronic, localized, verrucous VZV in a renal transplant recipient presenting with cutaneous dissemination. This case highlights the need to consider chronic VZV infection in the differential diagnosis of skin lesions even in the VZV seronegative transplant recipient without substantial exposure to antiviral agents.- - - - - - - - - - ranking = 0.14285714285714keywords = varicella (Clic here for more details about this article) |
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