1/19. Impact of cerebrospinal fluid PCR on the management of hiv-infected patients with varicella-zoster virus infection of the central nervous system.Over a 2 year period, we identified five hiv-infected patients who presented with central nervous system infection caused by varicella-zoster virus, three with myelitits, and two with meningoencephalitis. All five patients were profoundly immunocompromised. Clinical presentation of these patients overlapped to a significant extent with diseases caused by other viruses, e.g. CMV. Indeed, in one case, a dual infection with CMV was diagnosed, but the respective role of each virus was ascertained by in situ hybridisation. At the time of CNS involvement, only one patient had active VZV cutaneous lesions, which were instrumental in diagnosing her condition. In contrast, PCR for VZV dna in the CSF was helpful in making a diagnosis in the four other cases, one of which was confirmed by a post mortem. Of these five patients, two patients developed VZV disease while receiving oral acyclovir and had foscarnet treatment initiated when MRI demonstrated widespread lesions. They did not respond to antiviral therapy. The three other patients had intravenous acyclovir initiated at a time when no or limited parenchymal lesions were observed by MRI. Two of these three patients had VZV infection diagnosed solely on the basis of PCR: all three responded to treatment. Our data show that reactivation of VZV involving the central nervous system occurs frequently in the absence of cutaneous lesions. PCR of cerebrospinal fluid may help in making an early diagnosis which is probably a prerequisite for successful treatment of VZV infection of the CNS.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/19. Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of hiv infection.A 31-year-old man presented with acute pain in his left arm and hemorrhagic vesicles that followed his left 8th cervical nerve. A diagnosis of herpes zoster was made, and the patient was treated with valacyclovir. He refused testing for antibodies to hiv because he denied being at risk. Two months later he returned with postherpetic neuralgia and postherpetic hyperhidrosis in the distribution of the vesicles, which had since resolved. serology for hiv at this visit was positive, and the patient admitted to having sexual relations with prostitutes. Six months later the patient was being treated with triple antiretroviral therapy, and all signs and symptoms of postherpetic zoster had resolved. This case report documents the need for hiv testing in patients with unusual presentations of herpes zoster even if they initially deny being at risk.- - - - - - - - - - ranking = 0.8keywords = varicella (Clic here for more details about this article) |
3/19. Typical varicella zoster (ophthalmicus) in an hiv-infected person.A typical varicella zoster (ophthalmicus) in an incidentally hiv-infected person is reported in a young man. It was characterized by tense, grouped, vesiculobullous eruptions on a brick-red base. The diagnosis was substantiated by demonstration of swollen epidermal (balloon) cells with a nucleus/several nuclei containing inclusion bodies. Reticular degeneration was apparent.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
4/19. 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 = 1.4keywords = varicella (Clic here for more details about this article) |
5/19. Disseminated vaccine strain varicella as the acquired immunodeficiency syndrome-defining illness in a previously undiagnosed child.The food and Drug Administration licensed a live-virus varicella vaccine (Varivax; Merck & Co Inc, West Point, PA) in March 1995. Prelicensure adverse events were minimal; however, since licensure and increased vaccine use, rare previously undetected risks have arisen. Presented here is the clinical course of a previously undiagnosed, human immunodeficiency virus-infected boy who developed dissemination of the vaccine strain of varicella zoster after immunization. chickenpox, human immunodeficiency virus, pneumonia, encephalopathy, varicella vaccine, adverse events, dissemination.- - - - - - - - - - ranking = 1.4keywords = varicella (Clic here for more details about this article) |
6/19. Botryomycosis in an hiv-positive subject.A 28-year-old male AIDS patient with generalized painful skin ulcers, fever and malaise presented to us. The differential diagnosis included varicella zoster infection, herpes simplex infection, actinomycosis, sporotrichosis and botryomycosis. Histopathology revealed clusters of gram-positive coccoid bacteria in the deep dermis, surrounded by a mixed dense inflammatory infiltrate. A bacterial culture grew staphylococcus aureus. Viral cultures remained negative. Based on these findings botryomycosis was diagnosed. Large lesions were excised surgically and with antimicrobial therapy all skin symptoms disappeared. We discuss this case with reference to a short review of the literature on botryomycosis in relation to hiv infection.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
7/19. microdissection combined with the polymerase chain reaction to identify potentiating viral co-infection in patients with hiv/AIDS with ocular infection.BACKGROUND: In the presence of several coexisting infections, superimposed tissue necrosis or tissue metaplasia, it may be difficult to recognize standard histologic morphology on hematoxylin-eosin slides. Tissue microdissection combined with the polymerase chain reaction (PCR-MD) offers the advantages of high specificity and relative speed. The objective of this study was to describe the use of PCR-MD in identifying potentiating viral co-infection in patients with hiv/AIDS with retinitis and choroiditis. methods: Eyes from two patients with hiv/AIDS with several ocular infections were studied by a variety of techniques, including standard histologic examination, immunochemistry, electron microscopy and in situ hybridization. PCR-MD was used to identify coexisting viral infections. RESULTS: Histologic examination showed cytomegalovirus retinitis in both cases. Use of PCR-MD allowed the identification of Epstein-Barr virus within a zone of fulminant varicella-zoster virus retinitis in one patient. PCR-MD confirmed the presence of human herpesvirus 8 in the second patient, who had ocular lymphoma. INTERPRETATION: PCR-MD can be used to demonstrate coexisting viral infection in ocular specimens from patients with unusually fulminant courses. Co-infections may contribute to the observed clinical course and should be considered in patients with rapid progression or unusual presentation.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
8/19. Initial low CD4 lymphocyte counts in recent human immunodeficiency virus infection and lack of association with identified coinfections.Initial CD4 lymphocyte counts were studied in 244 patients with human immunodeficiency virus (hiv) seroconversion. The CD4 cell counts at initial presentation after seroconversion were normally distributed (mean, 579/mm3; SD, 252). The mean percentage of CD4 cells was 26.1% (SD, 5.6). CD4 cell counts were < 500/mm3 in 41% and < 200/mm3 in 4%. The mean calculated duration of hiv infection was 7.7 months, which was not significantly different between the highest and lowest CD4 count quartiles (8.1 vs. 7.9). Age, sex, race, and serologic evidence of toxoplasmosis, cytomegalovirus, hepatitis b, syphilis, and varicella-zoster virus were not associated with initial low CD4 cell counts; however, never-married men were significantly overrepresented in the lowest quartile. These findings suggest that extensive CD4 lymphocyte depletion is common in early hiv infection and that frequent screening is necessary to identify newly infected patients who would benefit from antiretroviral therapy.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
9/19. Nodular herpes zoster with herpetic syringitis and no epidermal involvement in a patient with burkitt lymphoma.herpes zoster (HZ) occurs with an increased incidence in immunosuppressed patients, in whom it frequently displays atypical clinical presentations. Herpetic syringitis, the involvement of the eccrine epithelium by herpes virus infection, is an infrequently described histologic pattern that has been rarely and almost exclusively reported in hiv-infected patients. We report the case of a woman with burkitt lymphoma who developed 2 nodular, asymptomatic lesions while receiving treatment with chemotherapy and radiotherapy for her hematological disease. histology showed viropathic changes in the epithelium of eccrine glands not in the epidermis. PCR was positive for varicella-zoster virus (VZV). Nodular herpes zoster seems to be an exceptional clinical presentation. We report another such case which is, as far as we know, the first report of herpetic syringitis with no concomitant epidermal involvement.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
10/19. Fulminant varicella hepatitis in a human immunodeficiency virus infected patient: case report and review of the literature.We report the case of a 35-y-old hiv-infected female, who presented fulminant varicella hepatitis and recovered under medical treatment. Varicella zoster virus is an uncommon cause of acute liver disease which occurs mainly in immunocompromised patients. acyclovir is the cornerstone of the treatment.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
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