1: Singapore Med J. 2008 Feb;49(2):e59-60.

Zosteriform herpes simplex.

Koh MJ, Seah PP, Teo RY.

Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore
529889. docmark@pacific.net.sg.

Herpes simplex virus (HSV) infection, though most commonly seen in the oral,
perioral and genital areas, can occur anywhere on the body. After primary
infection, HSV then establishes latency in sensory nerve ganglia and reactivates 
intermittently, precipitated by various factors. These reactivations may be
recurrent and appear in a dermatomal distribution, mimicking herpes zoster, often
leading to misdiagnosis if no confirmatory laboratory tests are carried out. We
report a 65-year-old man who presented with recurrent episodes of a "zosteriform 
eruption", who was initially clinically diagnosed and treated as for recurrent
herpes zoster, but was subsequently found to have recurrent herpes simplex virus 
type 2 after laboratory investigations.

PMID: 18301829 [PubMed - in process]

2: Nepal Med Coll J. 2007 Dec;9(4):281-3.

Herpes zoster in a five month old infant subsequent to intrauterine exposure to
varicella infection.

Jha A, Kumar A, Paudel U, Neupane S, Pokhrel DB, Badal KP.

Department of Pathology, Tribhuvan University Teaching Hospital, Maharajgunj
Campus, Maharajgunj, Kathmandu, Nepal. jhaabhimanyu@yahoo.com

Herpes zoster is characterized by painful vesicular eruption in a dermatomal
distribution of sensory nerves as a result of reactivation of latent herpes
zoster virus in posterior root ganglia. The primary varicella infection is
usually acquired in childhood and reactivation usually is seen in elderly. In
rare instances herpes zoster can also occur in infancy as a result of
reactivation of primary varicella infection acquired in utero or in early
infancy. Here, we report a rare case of herpes zoster in a 5 month baby who
acquired primary infection in utero from mother who had varicella infection at 6 
months of gestation.

PMID: 18298022 [PubMed - in process]

3: Rev Alerg Mex. 2007 Jul-Aug;54(4):134-9.

Indications, usage, and dosage of the transfer factor.

Berron-Perez R, Chavez-Sanchez R, Estrada-Garcia I, Espinosa-Padilla S,
Cortez-Gomez R, Serrano-Miranda E, Ondarza-Aguilera R, Perez-Tapia M, Pineda
Olvera B, Jimenez-Martinez Mdel C, Portugues A, Rodriguez A, Cano L, Pacheco PU, 
Barrientos J, Chacon R, Serafin J, Mendez P, Monges A, Cervantes E, Estrada-Parra
S.

Servicio de Inmunologia, Instituto Nacional de Pediatria, S.S.

The transfer factor (TF) was described in 1955 by S. Lawrence. In 1992
Kirkpatrick characterized the specific TF at molecular level. The TF is
constituted by a group of numerous molecules, of low molecular weight, from 1.0
to 6.0 kDa. The 5 kDa fraction corresponds to the TF specific to antigens. There 
are a number of publications about the clinical indications of the TF for diverse
diseases, in particular those where the cellular immune response is compromised
or in those where there is a deficient regulation of the immune response. In this
article we present our clinical and basic experiences, especially regarding the
indications, usage and dosage of the TF. Our group demonstrated that the TF
increases the expression of IFN-gamma and RANTES, while decreases the expression 
of osteopontine. Using animal models we have worked with M. tuberculosis, and
with a model of glioma with good therapeutic results. In the clinical setting we 
have worked with herpes zoster, herpes simplex type I, herpetic keratitis, atopic
dermatitis, osteosarcoma, tuberculosis, asthma, post-herpetic neuritis, anergic
coccidioidomycosis, leishmaniasis, toxoplasmosis, mucocutaneous candidiasis,
pediatric infections produced by diverse pathogen germs, sinusitis, pharyngitis, 
and otits media. All of these diseases were studied through protocols which main 
goals were to study the therapeutic effects of the TF, and to establish in a
systematic way diverse dosage schema and time for treatment to guide the
prescription of the TF.

PMID: 18297853 [PubMed - in process]

4: Niger J Clin Pract. 2007 Dec;10(4):283-6.

Ocular disorders in patients infected with the human immunodeficiency virus at
the University of Benin Teaching Hospital, Benin City, Nigeria.

Osahon AI, Onunu AN.

Department of Ophthalmology, University of Benin Teaching Hospital, Benin City,
Nigeria. osahonai@yahoo.com

AIMS: Ocular diseases occur at all stages of HIV infection. Reports have
documented that the prevalence of these diseases vary from region to region. Thus
the objective of this study is to determine the prevalence of these ocular
disorders among people infected with HIV at the University of Benin Teaching
Hospital, Benin City, Nigeria METHODS: The study was prospective in design and
all patients who tested positive for HIV antibodies over a 5-year period from
September 1997 to August 2002 in Dermatology and Ophthalmology Units at the
University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, were examined 
for the presence of ocular disease. RESULTS: Twenty-one of the 526 HIV-positive
patients had ocular disease, giving a prevalence rate of 4.0%. Their mean age was
39.5 +/- 10.5 years. Fourteen patients (2.7%) had Herpes zoster ophthalmicus,
four (0.8%) had Squamuos cell carcinoma, two (0.4%) had Kaposi's sarcoma while
one (0.2%) had Cytomegalovirus retinitis. The signs seen on ocular examination
were vesicular rash (66.7%) diminished vision (57.1%) corneal ulcers (38.0%),
conjunctival injection (38.0%), and eyelid nodules (28.6%), preauricular
lymphadenopathy (28.6%), purulent eye discharge (19.0), conjunctival nodules
(9.5%), papilledema (9.5%), ptosis (9.5%), sudden visual loss in both eyes
(9.5%), pupillary dilatation (4.8%), chemosis (4.8%), uveitis (4.8%), and retinal
hemorrhage (4.8%). CONCLUSIONS: In this study the prevalence of ocular disorders 
was 4.0% in the 526 HIV-positive patients studied. Herpes zoster ophthalmicus was
the commonest ocular disease encountered, occurring in 2.7% of the study
population. This is in keeping with reports from other parts of the world. We
recommend that young patients presenting with Herpes zoster ophthalmicus,
conjunctival Squamuos cell carcinoma and sudden onset bilateral blindness should 
be screened for HIV infection.

PMID: 18293635 [PubMed - in process]

5: J Gen Intern Med. 2008 Feb 20 [Epub ahead of print]

Live, Attenuated Varicella Zoster Vaccination of an Immunocompromised Patient.

Curtis KK, Connolly MK, Northfelt DW.

Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA.

A vaccine for the prevention of herpes zoster outbreaks in adults over the age of
60 years has recently been approved. A 76-year-old white female with a history of
recurrent left axillary breast cancer undergoing chemotherapy was given a
Zostavax(R) injection by her primary care physician. Eight days later, the
patient developed a rash. Given the recent administration of live, attenuated
varicella zoster virus (VZV), a diagnosis of disseminated cutaneous herpes zoster
was made. The patient was treated successfully with a course of famciclovir for
10 days and cephalexin for 7 days for a secondary bacterial infection. A review
of the medical literature disclosed no reports of Zostavax(R) given to adult
cancer patients immunocompromised by systemic chemotherapy. Therefore, we believe
this report is the first to describe the consequences of Zostavax(R)
administration to such a host. Clinicians should take care to review
contraindications and precautions prior to administering the Zostavax(R) vaccine.

PMID: 18286341 [PubMed - as supplied by publisher]

6: Br J Dermatol. 2008 Feb 16 [Epub ahead of print]

Primary manifestation of a zosteriform lichen planus: isotopic response following
herpes zoster sine herpete?

Mohrenschlager M, Engst R, Hein R, Ring J.

Department of Dermatology and Allergy Biederstein, Technical University of
Munich, Munich, Germany.

PMID: 18284381 [PubMed - as supplied by publisher]

7: Pharmacoeconomics. 2008;26(3):235-49.

Community and patient values for preventing herpes zoster.

Lieu TA, Ortega-Sanchez I, Ray GT, Rusinak D, Yih WK, Choo PW, Shui I, Kleinman
K, Harpaz R, Prosser LA.

Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and
Harvard Medical School, Boston, Massachusetts, USA.

OBJECTIVES: The US Advisory Committee on Immunization Practices has recently
recommended a new vaccine against herpes zoster (shingles) for routine use in
adults aged >/=60 years. However, estimates of the cost effectiveness of this
vaccine vary widely, in part because of gaps in the data on the value of
preventing herpes zoster. Our aims were to (i) generate comprehensive information
on the value of preventing a range of outcomes of herpes zoster; (ii) compare
these values among community members and patients with shingles and post-herpetic
neuralgia (PHN); and (iii) identify clinical and demographic characteristics that
explain the variation in these values. METHODS: Community members drawn from a
nationally representative survey research panel (n = 527) completed an
Internet-based survey using time trade-off and willingness-to-pay questions to
value a series of scenarios that described cases of herpes zoster with varying
pain intensities (on a scale of 0 to 10, where 0 represents no pain and 10
represents the worst imaginable pain) and duration (30 days to 1 year). Patients 
with shingles (n = 382) or PHN (n = 137) [defined as having symptoms for >/=90
days] from two large healthcare systems completed telephone interviews with
similar questions to the Internet-based survey and also answered questions about 
their current experience with herpes zoster. We constructed generalized linear
mixed models to evaluate the associations between demographic and clinical
characteristics, the length and intensity of the health states and time trade-off
and willingness-to-pay values. RESULTS: In time trade-off questions, community
members offered a mean of 89 (95% CI 24, 182) discounted days to avoid the least 
severe scenario (pain level of 3 for 1 month) and a mean of 162 (95% CI 88, 259) 
discounted days to avoid the most severe scenario (pain level of 8 for 12
months). Compared with patients with shingles, community members traded more days
to avoid low-severity scenarios but similar numbers of days to avoid
high-severity scenarios. Compared with patients with PHN, community members
traded fewer days to avoid high-severity scenarios. In multivariate analyses,
older age was the only characteristic significantly associated with higher time
trade-off values.In willingness-to-pay questions, community members offered a
mean of $US450 (95% CI 203, 893) to avoid pain of level 3 for 1 month and a mean 
of $US1384 (95% CI 873, 2050) [year 2005 values] to avoid pain of level 8 for 12 
months. Community members traded less money than patients with either shingles or
PHN to avoid both low- and high-severity scenarios (p-values <0.05 to <0.001). In
multivariate models, male gender, higher income and having experienced shingles
or PHN were associated with higher willingness to pay to avoid herpes zoster.When
patients were asked to assign a value to avoiding their own case of herpes
zoster, those with shingles assigned a mean of 67 days or $US2319, while those
with PHN assigned a mean of 206 days or $US18 184. Both the time and monetary
value traded were associated with the maximum intensity of the pain the
individual had experienced, but neither was associated with the duration of the
pain. CONCLUSIONS: We believe that this study provides the most comprehensive
information to date on the value individuals place on preventing herpes zoster,
and it includes the only such valuation from nationally representative community 
members as well as patients with herpes zoster. Community members would trade
substantial amounts of time or money to avoid herpes zoster, even in the least
severe scenarios. The time trade-off results in this study may differ from those 
in other studies because of important differences in methods of assessing health 
utilities. Consideration of both community and patient perspectives is crucial to
help decision makers fully determine the implications of their policies now that 
a vaccine against herpes zoster is available.

PMID: 18282017 [PubMed - in process]

8: Ophthalmology. 2008 Feb;115(2 Suppl):S35-8.

Preventing herpes zoster through vaccination.

Gelb LD.

Division of Infectious Disease, Washington University School of Medicine,
Department of Internal Medicine, Barnes-Jewish Medical Center, St. Louis,
Missouri 63110, USA. ldgelb@swbell.net

TOPIC: The role of the zoster vaccine in the prevention of herpes zoster and its 
sequelae, including postherpetic neuralgia (PHN) and herpes zoster ophthalmicus. 
CLINICAL RELEVANCE: Wide administration of the herpes zoster vaccine in
accordance with the recommendations of the Centers for Disease Control and
Prevention Advisory Committee on Immunization Practices (ACIP) will lead to a
decline in the incidence and morbidity of herpes zoster and its complications,
including PHN. METHODS: The key study leading to the approval of the zoster
vaccine for use, the Centers for Disease Control and Prevention ACIP's
recommendations for appropriate use of the zoster vaccine, and predictions
regarding the cost efficacy of a zoster vaccination program are reviewed.
RESULTS: The Shingles Prevention Study established that the zoster vaccine was
safe, well tolerated, and effective in reducing the burden of illness due to
herpes zoster and the incidence of PHN. The ACIP recommended that the zoster
vaccine be given to adults 60 and older for the prevention of herpes zoster.
Cost-efficacy analyses suggest that the greatest gain in quality-adjusted
life-years can be gained by vaccinating individuals at the younger end of the
ACIP-recommended age range. CONCLUSION: The zoster vaccine promises to reduce the
morbidity and mortality of herpes zoster. Administering the vaccine at the
younger end of the age range may offer a greater cost benefit.

Publication Types: 
    Review

PMID: 18243932 [PubMed - indexed for MEDLINE]

9: Ophthalmology. 2008 Feb;115(2 Suppl):S33-4.

Use of photorefractive keratectomy in a patient with a corneal scar secondary to 
herpes zoster ophthalmicus.

Kaufman SC.

Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota
55455, USA. corneamd2000@yahoo.com

TOPIC: The use of LASIK surgery to correct vision in a patient with postzoster
corneal scarring. CLINICAL RELEVANCE: The cornea is commonly involved in cases of
herpes zoster ophthalmicus, and as a result, corneal scarring after a
varicella-zoster virus corneal infection is common. Corneal scars can be treated 
by lamellar keratoplasty or keratectomy, which may be performed using a
microkeratome or excimer laser phototherapeutic keratectomy (PTK). However,
articles on studies concerning the treatment of postherpetic scars by PTK have
been published, offering conflicting results. LASIK surgery may offer an
additional therapeutic approach to corneal scarring. METHODS: A patient seeking
corrective surgery to improve vision was found to have corneal scarring. RESULTS:
The patient experienced successful vision correction. CONCLUSION: LASIK surgery
can be conducted even in a patient with postzoster corneal scarring. No
complications were apparent in this case.

Publication Types: 
    Case Reports

PMID: 18243931 [PubMed - indexed for MEDLINE]

10: Ophthalmology. 2008 Feb;115(2 Suppl):S3-12.

Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, 
and morbidity.

Liesegang TJ.

Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA.
tliesegang@mayo.edu

TOPIC: The incidence and morbidity of herpes zoster (HZ) and HZ ophthalmicus
(HZO), and the potential impact of varicella vaccine on their epidemiology.
CLINICAL RELEVANCE: Herpes zoster affects 20% to 30% of the population at some
point in their lifetime; approximately 10% to 20% of these individuals will have 
HZO. METHODS: The peer-reviewed literature published from 1865 to the present was
reviewed. RESULTS: Herpes zoster is the second clinical manifestation of
varicella-zoster virus (VZV). The incidence and severity of HZ increase with
advancing age. Varicella-zoster virus-specific cell-mediated immunity, which
keeps latent VZV in check and is boosted by periodic reexposure to VZV, is an
important mechanism in preventing VZV reactivation as zoster. Thus, widespread
varicella vaccination may change the epidemiology of HZ. Herpes zoster
ophthalmicus occurs when HZ presents in the ophthalmic division of the fifth
cranial nerve. Ocular involvement occurs in approximately 50% of HZ patients
without the use of antiviral therapy. There is a long list of complications from 
HZ, including those that involve the optic nerve and retina in HZO, but the most 
frequent and debilitating complication of HZ regardless of dermatomal
distribution is postherpetic neuralgia (PHN), a neuropathic pain syndrome that
persists or develops after the zoster rash has resolved. The main risk factor for
PHN is advancing age; other risk factors include severe acute zoster pain and
rash, a painful prodrome, and ocular involvement. Many cases of HZ, HZO, and PHN 
can be prevented with the zoster vaccine. CONCLUSION: Vaccination is key to
preventing HZ, HZO, and PHN, but strategies for both varicella and HZ vaccines
will need to be evaluated and adjusted periodically as changes in the
epidemiology of these VZV diseases become more evident.

Publication Types: 
    Review

PMID: 18243930 [PubMed - indexed for MEDLINE]

11: Ophthalmology. 2008 Feb;115(2 Suppl):S24-32.

Anterior segment complications of herpes zoster ophthalmicus.

Kaufman SC.

Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota
55455, USA. corneamd2000@yahoo.com

TOPIC: The clinical features and management strategies for varicella-zoster virus
(VZV) infections of the cornea, lids, and adnexa. CLINICAL RELEVANCE: Herpes
zoster ophthalmicus (HZO) can result in a myriad of chronic and recurrent
complications that may be sight threatening. Surgical intervention is the
mainstay of treatment, and advancements in this area may lessen the complications
of HZO if correctly implemented. METHODS: Literature review of pertinent topics, 
authors, and journals utilizing the National Institutes of Health PubMed service.
RESULTS: A higher rate of treatment success for VZV-related complications was
obtained when any preexisting ocular inflammation, increased intraocular
pressure, lagophthalmos, dry eye, exposure, or neurotrophic keratitis was treated
and under control before attempting ocular surgery. CONCLUSION: Options are
available to manage ophthalmic complications of HZO and reduce the risk of
treatment failure.

Publication Types: 
    Review

PMID: 18243929 [PubMed - indexed for MEDLINE]

12: Ophthalmology. 2008 Feb;115(2 Suppl):S21-3.

Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy.

Pavan-Langston D, Dohlman CH.

Massachusetts Eye And Ear Infirmary, Harvard Medical School, Boston,
Massachusetts 02114, USA. deborah.langston@schepens.harvard.edu

TOPIC: The successful use of the Boston keratoprosthesis in a severely inflamed
ulcer in herpes zoster neurotrophic keratopathy. CLINICAL RELEVANCE:
Approximately 10% to 20% of patients with herpes zoster will develop herpes
zoster ophthalmicus (HZO). Antiviral medication forms the foundation of
pharmacologic treatment for acute herpes zoster, but management of HZO is
supplemented with topical and systemic antimicrobials and corticosteroid agents
as well as surgical interventions. However, HZO is associated with poor healing, 
as evidenced by a high occurrence of ulceration, superinfection, and surgical
failure. METHODS: A 95-year-old man was referred for corneal edema in the right
eye. There was a history of acute herpes zoster in the right eye 10 months
previously. Slit-lamp examination revealed lagophthalmos, ectropion, total
corneal anesthesia, and marked inferior corneal edema. Despite surgical repair of
all lid abnormalities and aggressive lubrication and management of rosacea
blepharitis, the corneal surface remained unhealthy. Four months later, the
patient presented with an inflamed hypopyon ulcer, culture positive for abundant 
Pseudomonas and Candida albicans. The ulcer progressed to descemetocele in the
face of aggressive antimicrobial therapy, vision was light perception (LP), and
perforation became imminent. A Boston keratoprosthesis was used to replace the
severely damaged cornea, and extracapsular cataract extraction of a mature
cataract was also performed. RESULTS: One week after surgery, the inflammation
was almost entirely resolved, and cultures of the host button were negative for
any organisms. Vision gradually increased from LP to 20/60 over the ensuing 4
months. CONCLUSION: The Boston keratoprosthesis procedure successfully salvaged
and restored vision in this high-risk herpes zoster eye in which standard
keratoplasty would almost certainly have failed.

Publication Types: 
    Case Reports

PMID: 18243928 [PubMed - indexed for MEDLINE]

13: Ophthalmology. 2008 Feb;115(2 Suppl):S13-20.

Herpes zoster antivirals and pain management.

Pavan-Langston D.

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston,
Massachusetts 02114, USA. deborah.langston@meei.harvard.edu

TOPIC: Evaluation of evidence-based strategies for managing herpes zoster (HZ)
and the pain of postherpetic neuralgia (PHN). CLINICAL RELEVANCE: Approximately
20% of the world's population suffers from herpes zoster at least once in a
lifetime, with 10% to 20% having ophthalmic involvement. Treatment of the acute
disease with oral antivirals may reduce the incidence and severity of
complications but does not reliably prevent PHN or postherpetic itch (PHI). The
acute pain abates as the acute phase resolves; the long-term pain of PHN or PHI
may be severe and difficult to manage. Although many therapeutic agents have
efficacy in the management of these complications, relief is frequently partial
for months to the remainder of the lifetime. METHODS: Literature review was
performed using the resources of the Harvard Medical School/Massachusetts Eye and
Ear Infirmary Ophthalmic library as well as the National Library of Medicine and 
the National Institutes of Health PubMed service searching by pertinent topics,
authors, and journals. RESULTS: If started within 72 hours of the onset of the
acute HZ rash, the oral antiviral agents acyclovir, valacyclovir, and famciclovir
significantly shorten the periods of acute pain, virus shedding, rash, acute and 
late-onset anterior segment complications, and, in the case of valacyclovir and
famciclovir, the incidence and severity of PHN. However, these medications do not
prevent PHN, which remains a common and debilitating complication of HZ in older 
patients, requiring assiduous pain management. Tricyclic antidepressants,
antiseizure drugs, opioids, and topical analgesics all offer some pain relief,
and may be combined. CONCLUSION: Options are available to manage HZ and reduce
the pain of PHN. However, prevention, now possible with the HZ vaccine, is
preferable to treatment.

Publication Types: 
    Review

PMID: 18243927 [PubMed - indexed for MEDLINE]

14: J Infect Dis. 2008 Feb 8 [Epub ahead of print]

Varicella-Zoster Virus in the Saliva of Patients with Herpes Zoster.

Mehta SK, Tyring SK, Gilden DH, Cohrs RJ, Leal MJ, Castro VA, Feiveson AH, Ott
CM, Pierson DL.

1Enterprise Advisory Services, Inc., 2Space Life Sciences, National Aeronautics
and Space Administration, Lyndon B. Johnson Space Center, and 3University of
Texas Health Science Center, Houston; Departments of 4Neurology and
5Microbiology, University of Colorado Health Sciences Center, Denver.

Fifty-four patients with herpes zoster were treated with valacyclovir. On
treatment days 1, 8, and 15, pain was scored and saliva examined for
varicella-zoster virus (VZV) DNA. VZV DNA was found in every patient the day
treatment was started and later disappeared in 82%. There was a positive
correlation between the presence of VZV DNA and pain and between VZV DNA copy
number and pain ([Formula: see text]). VZV DNA was present in 1 patient before
rash and in 4 after pain resolved and was not present in any of 6 subjects with
chronic pain or in 14 healthy subjects. Analysis of human saliva has potential
usefulness in the diagnosis of neurological disease produced by VZV without rash.

PMID: 18260763 [PubMed - as supplied by publisher]

15: J Infect Dis. 2008 Feb 8 [Epub ahead of print]

Herpes Zoster: New Insights Provide an Important Wake-Up Call for Management of
Nosocomial Transmission.

Breuer J.

Barts and The London School of Medicine and Dentistry, London, United Kingdom.

PMID: 18260760 [PubMed - as supplied by publisher]

16: J Infect Dis. 2008 Feb 8 [Epub ahead of print]

Transmission of a Newly Characterized Strain of Varicella-Zoster Virus from a
Patient with Herpes Zoster in a Long-Term-Care Facility, West Virginia, 2004.

Lopez AS, Burnett-Hartman A, Nambiar R, Ritz L, Owens P, Loparev VN, Guris D,
Schmid DS.

1Division of Viral Diseases, National Center for Immunizations and Respiratory
Diseases, and 2Biotechnology Core Facility, Coordinating Center for Infectious
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 3Division
of Surveillance and Disease Control, Infectious Disease Epidemiology Program,
West Virginia Department of Health and Human Resources, Charleston, and 4Marshall
County Health Department, Moundsville, West Virginia.

We investigated a small outbreak of varicella in a long-term-care facility after 
a case of herpes zoster. Clinical specimens and environmental samples were
collected from all case patients and from surfaces in the case patients' rooms
and other common-use areas. Wild-type varicella-zoster virus (VZV) DNA was
identified in all 3 varicella case patients, and high concentrations of VZV DNA
were detected in environmental samples from the room of the herpes zoster case
patient. Genotypic analysis showed that the identical VZV strain was present in
all samples; moreover, the strain was a unique Mosaic genotype isolate that
included a stable Oka vaccine marker that had hitherto never been observed in a
wild-type strain of VZV. This study provides evidence for the value of including 
environmental sampling during the investigation of varicella outbreaks and
illustrates the importance of evaluating multiple vaccine-associated markers for 
the discrimination of vaccine virus from wild-type VZV.

PMID: 18260757 [PubMed - as supplied by publisher]

17: Zhongguo Zhen Jiu. 2007 Oct;27(10):729-30.

[Observation on therapeutic effect of pricking blood therapy combined with
acupuncture on herpes zoster]

[Article in Chinese]

Huo HM, Yang XP.

Department of Dermatology, Jimo Third People's Hospital, Shandong 266200, China.

OBJECTIVE: To compare the therapeutic effects of pricking blood therapy combined 
with acupuncture and routine western medicine on herpes zoster. METHODS: Two
hundred and forty cases were randomly divided into 2 groups, 120 cases in each
group. The treatment group were treated with acupuncture combined with pricking
blood therapy on the point with the most pain, and cupping and surround needling;
the control group with external application and oral administration of Aciclovir 
plaster and Aciclovir tablets, respectively. Their therapeutic effects were
compared. RESULTS: The total effective rate was 92.5% in the treatment group and 
55.8% in the control group with a very significant difference between the two
groups (P < 0.01). The time of producing killing pain, stopping vesication and
scabbing in the treatment group was shorter than that in the control group.
CONCLUSION: The pricking blood therapy combined with acupuncture is an effective 
therapy for herpes zoster.

Publication Types: 
    English Abstract
    Randomized Controlled Trial

PMID: 18257346 [PubMed - indexed for MEDLINE]

18: Drug Ther Bull. 2008 Feb;46(2):14-6.

Lidocaine plasters for postherpetic neuralgia?

BMJ Group.

Each year in the UK, about 1 in 2,500 people experiences neuropathic pain that is
still present 3-6 months after acute herpes zoster (shingles). This condition,
known as postherpetic neuralgia, is the most common complication of herpes zoster
and can be chronic, intractable and distressing. Treatments used in an attempt to
reduce postherpetic neuralgia include tricyclic antidepressants (e.g.
amitriptyline--an unlicensed indication), antiepileptics (e.g. gabapentin) and
opioid analgesics, as well as topical treatments such as capsaicin. However, such
treatments may only provide partial pain relief, and tolerability can be a
problem, particularly in older patients. Versatis (Grunenthal Ltd), a topical
preparation of lidocaine formulated in a plaster, has recently been licensed for 
treating patients with postherpetic neuralgia. Does it offer useful benefit?

PMID: 18256177 [PubMed - in process]

19: J Virol. 2008 Feb 6 [Epub ahead of print]

Mechanisms of Varicella-Zoster Virus Neuropathogenesis in Human Dorsal Root
Ganglia.

Reichelt M, Zerboni L, Arvin AM.

Departments of Pediatrics and Microbiology & Immunology, Stanford University
School of Medicine, Stanford, CA, 94305.

Varicella-zoster virus (VZV) is a human alphaherpesvirus that infects sensory
ganglia and reactivates from latency to cause herpes zoster. VZV replication was 
examined in human dorsal root ganglia (DRG) xenografts in mice with severe
combined immunodeficiency using multiscale correlative immunofluorescence and
electron microscopy (IF-EM). These experiments showed the presence of VZV genomic
DNA, viral proteins and virion production in both neurons and satellite cells
within DRG. Furthermore, the multiscale analysis of VZV-host cell interactions
revealed virus-induced cell-cell fusion and polykaryon formation between neurons 
and satellite cells during VZV replication in DRG in vivo. Satellite cell
infection and polykaryon formation in neuron-satellite cell complexes provide
mechanisms to amplify VZV entry into neuronal cell bodies, which is necessary for
VZV transfer to skin in the affected dermatome during herpes zoster. These
mechanisms of VZV neuropathogenesis help to account for the often severe
neurologic consequences of herpes zoster.

PMID: 18256143 [PubMed - as supplied by publisher]

20: Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005582.

Corticosteroids for preventing postherpetic neuralgia.

He L, Zhang D, Zhou M, Zhu C.

BACKGROUND: Postherpetic neuralgia is a common serious complication of herpes
zoster. Corticosteroids are anti-inflammatory and might be beneficial.
OBJECTIVES: To examine the efficacy of corticosteroids in preventing postherpetic
neuralgia. SEARCH STRATEGY: Search for randomised or quasi-randomised controlled 
trials for corticosteroids for preventing postherpetic neuralgia in MEDLINE (1950
to 2006), EMBASE (1980 to 2006), LILACS (1982 to 2005), the Chinese Biomedical
Retrieval System (1978 to 2006) and the Cochrane Register of Controlled Trials
(CENTRAL) (Cochrane Library Issue 3, 2006). Date of most recent search: September
2006. SELECTION CRITERIA: Types of studies: quasi-randomised or randomised
controlled trialsTypes of participants: people of all ages with herpes zoster of 
all degrees of severity within seven days after onset.Types of interventions: all
kinds of corticosteroids given by oral, intramuscular or intravenous routes
during the acute stage (starting within one week of onset of the rash) compared
with no treatment or placebo, but not with other treatments. We also included
trials which compared corticosteroids plus routine treatment with placebo plus
routine treatment.Types of outcome measures:Primary: the presence of postherpetic
neuralgia six months after the onset of the acute herpetic rash.Secondary: pain
severity measured by a validated visual analogue scale or numerical descriptive
scale after three, six and 12 months; quality of life measured with the short
form 36 questionnaire after six months; adverse events during or within two weeks
after stopping treatment. DATA COLLECTION AND ANALYSIS: Data were extracted by
two independent reviewers. MAIN RESULTS: Five trials were included with
altogether 787 participants. All were randomised, double-blind,
placebo-controlled parallel group studies. Our primary outcome measure was the
presence of postherpetic neuralgia six months after the onset of the acute
herpetic rash. There was no significant difference between the corticosteroid and
control groups for the primary outcome (RR 1.27, 95% CI 0.20 to 7.97). There was 
also no significant difference between the corticosteroid plus antiviral agents
and placebo plus antiviral agents groups for the primary outcome (RR 0.90, 95% CI
0.40 to 2.03). No included trials evaluated pain severity with a validated visual
analogue scale or numerical descriptive scale and also no trials measured quality
of life with the Short Form 36 questionnaire. Adverse events during or within two
weeks after stopping treatment were reported by all five included trials, but
after meta-analysis, there was no significant difference in any serious adverse
event (death, acute cardiac insufficiency, rash dissemination, bacterial
pneumonia or haematemesis) or non serious adverse event (dizziness, nausea,
vomiting, hypertension or hyperglycaemia). AUTHORS' CONCLUSIONS: There was
insufficient evidence to conclude that corticosteroids are safe or effective in
the prevention of postherpetic neuralgia. More randomised controlled trials with 
a greater number of participants are needed to determine reliably whether there
is real benefit (or harm) from the use of corticosteroid therapy to prevent
postherpetic neuralgia. Future trials should measure function and quality of
life.

PMID: 18254083 [PubMed - in process]

21: Emerg Med Clin North Am. 2008 Feb;26(1):217-31.

Ophthalmologic complications of systemic disease.

Klig JE.

Division of Pediatric Emergency Medicine, Boston University School of Medicine,
Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA.

The human eye, as an organ, can offer critical clues to the presence of systemic 
disease. This article discusses the various ophthalmologic manifestations of
systemic disease that can be evident on examination by an emergency department
provider, as well as some findings that can be discerned with specialty
consultation. The following topics are reviewed with respect to potential ocular 
signs and complications: syphilis, herpes zoster, Lyme disease, acquired
immunodeficiency syndrome, Reiter's syndrome, Kawasaki's disease, temporal
arteritis, endocarditis, hypertension, and diabetes mellitus. Indications for
emergent ophthalmologic consultation are also emphasized.

PMID: 18249264 [PubMed - in process]

22: Br J Ophthalmol. 2008 Feb 1 [Epub ahead of print]

Association of varicella-zoster virus (VZV) load in the aqueous humor with
clinical manifestations of anterior uveitis in herpes zoster ophthalmicus and
zoster sine herpete.

Kido S, Sugita S, Horie S, Miyanaga M, Miyata K, Shimizu N, Morio T, Mochizuki M.

Japan.

Aim: To investigative whether clinical manifestations of anterior uveitis is
associated with the viral load of varicella-zoster virus (VZV) in the aqueous
humor in patients with herpes zoster ophthalmicus (HZO) and zoster sine herpete
(ZSH). Methods: After informed consent was given, an aliquot of aqueous humor was
collected from patients with VZV anterior uveitis (n=8). Using the aqueous humor,
genomic DNAs of the human herpes viruses were measured through the use of two
polymerase chain reaction (PCR) assays: (1) a qualitative multiplex PCR and (2) a
quantitative real-time PCR. Results: All patients had unilateral acute anterior
uveitis with high intraocular pressure, mutton fat keratic precipitates with some
pigmentation, and trabecular meshwork pigmentation. Multiplex PCR demonstrated
VZV genomic DNA in all of the samples, but not in other human herpes virus
samples (HSV-1, HSV-2, EBV, CMV, HHV-6, HHV-7, and HHV-8). Real-time PCR revealed
a high copy number of VZV DNA in the aqueous humor. During the time after the
initial onset of the anterior uveitis, iris atrophy and a distorted pupil with
paralytic mydriasis developed in the patients. The intensity of the iris atrophy 
and pupil distortion, but not the ocular hypertension, was correlated with the
viral load of VZV in the aqueous humor. Conclusion: Viral load of VZV in the
aqueous humor was well correlated with the tissue damage of the iris (iris
atrophy and pupil distortion) in patients with HZO and ZSH.

PMID: 18245272 [PubMed - as supplied by publisher]

23: Med J Aust. 2008 Feb 4;188(3):171-6.

The prevention and management of herpes zoster.

Cunningham AL, Breuer J, Dwyer DE, Gronow DW, Helme RD, Litt JC, Levin MJ,
Macintyre CR.

Westmead Millennium Institute for Medical Research and University of Sydney,
Sydney, NSW, Australia. tony_cunningham@wmi.usyd.edu.au.

The burden of illness from herpes zoster (HZ) and postherpetic neuralgia (PHN) in
the Australian community is high. The incidence and severity of HZ and PHN
increase with age in association with a progressive decline in cell-mediated
immunity to varicella-zoster virus (VZV). Antiviral medications (valaciclovir,
famciclovir, aciclovir) have been shown to be effective in reducing much but not 
all of the morbidity associated with HZ and PHN, but are consistently
underprescribed in Australia. Zoster-associated pain should be treated early and 
aggressively, as it is more difficult to treat once established. Clinicians
should be proactive in their follow-up of individuals at high risk of developing 
PHN, and refer patients to a specialist pain clinic earlier, rather than later. A
live, attenuated VZV vaccine (Oka/Merck strain, Zostavax [Merck Sharp & Dohme])
has proven to be efficacious in reducing the incidence of and morbidity
associated with HZ and PHN in older adults. The vaccine's efficacy has been shown
to persist for at least 4 years, but is likely to last a lot longer. Ongoing
surveillance will determine the duration of protection and whether a booster dose
is required. Clinicians should consider recommending the vaccine, which can be
safely administered at the same time as the inactivated influenza vaccine, to all
immunocompetent patients aged 60 years or older. Clinicians should refer to the
Australian immunisation handbook for advice on the use of the live vaccine in
immunosuppressed individuals.

PMID: 18241179 [PubMed - in process]

24: Harv Womens Health Watch. 2007 Oct;15(2):8.

By the way, doctor. I'm 67 and had shingles four years ago. Am I immune to it
now? If not, should I get the new shingles vaccine?

Robb-Nicholson C.

PMID: 18240445 [PubMed - indexed for MEDLINE]

25: Blood. 2008 Jan 31 [Epub ahead of print]

Risk of multiple myeloma and monoclonal gammopathy of undetermined significance
among white and black male United States veterans with prior autoimmune,
infectious, inflammatory, and allergic disorders.

Brown LM, Gridley G, Check D, Landgren O.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, National
Institutes of Health, Department of Health & Human Services, Bethesda, MD, United
States.

In a retrospective cohort of more than 4 million white and black male United
States veterans, we explored the role of specific prior autoimmune, infectious,
inflammatory, and allergic disorders in the etiology of multiple myeloma (MM) and
monoclonal gammopathy of undetermined significance (MGUS). Subjects were selected
from computerized inpatient discharge records at United States Veterans Affairs
hospitals. The analysis included 4641 patients (3040 white, 1601 black) and 2046 
patients (1312 white; 734 black) with a discharge diagnosis of MM and MGUS,
respectively. Using Poisson regression we calculated age-adjusted relative risks 
(RR) and 95% confidence intervals (CI) for the relationship between MM, MGUS and 
specific prior medical conditions. Significantly elevated risks of MM were
associated with broad categories of autoimmune (RR, 1.15; 95% CI, 1.02-1.28),
infectious (RR, 1.29; 95% CI, 1.20-1.38), and inflammatory disorders (RR, 1.18;
95% CI, 1.10-1.27) and specific prior autoimmune (polymyositis/dermatomyositis,
systemic sclerosis, autoimmune hemolytic anemia, pernicious anemia, and
ankylosing spondylitis), infectious (pneumonia, hepatitis, meningitis,
septicemia, herpes zoster, and poliomyelitis), and inflammatory
(glomerulonephritis, nephrotic syndrome, and osteoarthritis) disorders. Risks for
MGUS were generally of similar magnitude. Our results indicate that various types
of immune-mediated conditions might act as triggers for MM/MGUS development.

PMID: 18239085 [PubMed - as supplied by publisher]

26: Brain Nerve. 2008 Jan;60(1):79-83.

[A case of varicella myelitis for nursing care worker]

[Article in Japanese]

Takei-Suzuki M, Hayashi Y, Kimura A, Nagasawa M, Koumura A, Sakurai T, Tanaka Y, 
Hozumi I, Inuzuka T.

Department of Neurology and Geriatrics, Gifu University Graduate School of
Medicine, Yanagido, Japan.

Varicella myelitis is very rarely observed in healthy adult. We report the case
of 25-year-old nursing care worker who suffered from chickenpox for the first
time. Approximately 2 weeks prior to the development of the symptoms, she cared
for an old man who suffered from herpes zoster. She was admitted to our hospital,
and she complained of weakness and paresthesia in the lower limbs. Subsequently, 
she experienced vesicorectal disorders: this was followed 5 days later by the
appearance of a rash. Spinal T2-weighted MR images showed a high-intensity lesion
in the spinal cord at the level of Th9/10, and both IgM-type anti-VZV antibodies 
and VZV-DNA were present in her cerebrospinal fluid. Treatment comprising a
combination of acyclovir at 1,500 mg/day for 14 days and gamma-globulin with high
titer of IgG-type anti-VZV antibodies at 5 g/day for 5 days result in remarkable 
improvement. She was able to walk again. The high-intensity lesion in the spinal 
T2-weighted MR images disappeared. Urinary dysfunction disappeared completely
after 5 months. Care persons without anti-IgG antibodies against VZV are at a
high risk of contracting varicella infection. Guidelines for infection control in
home care, as well as hospitals, are necessary for caregivers.

Publication Types: 
    English Abstract

PMID: 18232335 [PubMed - in process]

27: Int Tinnitus J. 2007;13(2):90-3.

Viral infection and serum antibodies to heat shock protein 70 in the acute phase 
of Meniere's disease.

DiBerardino F, Cesarani A, Hahn A, Alpini D.

Department of Audiology-Ear, Nose, and Throat, I.R.C.C.S. Fondazione Policlinico,
Mangiagalli e Regina Elena, University of Milan, Italy.
federica.diberardino@unimi.it

Meniere's disease (MD) is an idiopathic inner-ear disorder characterized by
fluctuating hearing loss, episodic vertigo, and tinnitus. Though MD's etiology is
unknown, growing evidence suggests that autoimmunity may be involved in its
development. The aim of this prospective study was to investigate the presence of
anti-heat shock protein 70 (anti-HSP70) antibodies during the acute phase of MD
and to relate its presence to the antibody pattern. We examined the sera of 13
patients by Western blot immunoassays for reactivity to bovine inner-ear antigen 
(anti-HSP70) antibodies. The presence of viral antibodies and autoantibodies
(herpes simplex, types 1, 2; herpes zoster; cytomegalovirus; Epstein-Barr; IgM;
IgG; cardiolipin; thyroglobulin and thyroperoxidase; and antinuclear,
antimitochondrial, and anti-smooth-cell antibodies) were also tested. We found
reactivity to HSP70 in only 1 of the 13 MD patients (7.7%), and it occurred
during herpes zoster reactivation. We found no relationship between the presence 
of antibodies to HSP70 and immunological or viral testing.

PMID: 18229786 [PubMed - in process]

28: Mayo Clin Health Lett. 2007 Oct;25(10):4.

Vaccine cuts by half the risk of developing shingles.

[No authors listed]

Publication Types: 
    News

PMID: 18229411 [PubMed - indexed for MEDLINE]

29: J Pain. 2008 Jan;9(1 Suppl 1):S37-44.

Diagnosis and assessment of pain associated with herpes zoster and postherpetic
neuralgia.

Dworkin RH, Gnann JW Jr, Oaklander AL, Raja SN, Schmader KE, Whitley RJ.

Department of Anesthesiology and Neurology, University of Rochester School of
Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
robert_dworkin@urmc.rochester.edu

Accurate evaluation of pain plays a critical role in identifying new
interventions for the treatment and prevention of herpes zoster and postherpetic 
neuralgia (PHN). Different types of pain and other sensory symptoms are found in 
patients with herpes zoster, and these vary greatly with respect to their
presence, location, duration, intensity, and quality. The results of recent
studies of herpes zoster and PHN and the development of new methods for assessing
neuropathic pain provide a foundation for diagnosing and assessing the pain
associated with herpes zoster. We review the results of recent research to
identify the essential components that must be considered in developing an
evidence-based description of pain associated with herpes zoster and PHN.
PERSPECTIVE: Comprehensive assessments of pain are necessary for clinical
research on the epidemiology, natural history, pathophysiologic mechanisms,
treatment, and prevention of pain in herpes zoster and PHN.

PMID: 18166464 [PubMed - in process]

30: J Pain. 2008 Jan;9(1 Suppl 1):S31-6.

Vaccination to prevent herpes zoster in older adults.

Gnann JW Jr.

Departments of Medicine, Pediatrics, and Microbiology, University of Alabama at
Birmingham, 908 20th Street South, Birmingham, AL 35294, USA. jgnann@uab.edu

Herpes zoster causes substantial morbidity, especially among older adults.
Although the acute cutaneous manifestations can be painful and troublesome, the
most important consequence of herpes zoster (shingles) is the chronic pain
syndrome known as postherpetic neuralgia (PHN). Previous studies have suggested
that declining varicella-zoster virus (VZV)-specific cell-mediated immune (CMI)
responses account for the increased frequency of herpes zoster seen in older
adults. This led to the idea that immunization designed to boost VZV-specific CMI
responses might reduce the risk of herpes zoster. This hypothesis was tested in a
large, randomized, placebo-controlled clinical trial called the Shingles
Prevention Study (SPS). Compared with the placebo group, herpes zoster vaccine
recipients had a 61.1% reduction in zoster "burden of illness" (an index
incorporating incidence and severity of herpes zoster); a 66.5% reduction in the 
incidence of postherpetic neuralgia; and a 51.3% reduction in the incidence of
herpes zoster. The incidence of serious adverse events was not different between 
the overall vaccine and placebo populations. The most frequently encountered
adverse event among vaccine recipients was local reactogenicity, with
self-limited and generally mild tenderness, warmth, or erythema occurring at the 
injection site in about one-half of vaccine recipients. The zoster vaccine was
approved by the US Food and Drug Administration in 2006 and is indicated for
prevention of herpes zoster in immunocompetent persons aged 60 years and older.
PERSPECTIVE: The herpes zoster vaccine provides physicians with an effective
means for reducing a patient's risk for developing shingles and its attendant
complications. No significant safety concerns regarding the vaccine have been
identified. Indications for use of the attenuated-virus vaccine in special
subpopulations continue to evolve.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18166463 [PubMed - in process]

31: J Pain. 2008 Jan;9(1 Suppl 1):S10-8.

Mechanisms of pain and itch caused by herpes zoster (shingles).

Oaklander AL.

Departments of Neurology and Pathology, Massachusetts General Hospital, Harvard
Medical School, 275 Charles Street, Boston, MA 02114, USA.
aoaklander@partners.org

Study of humans with shingles or postherpetic neuralgia (PHN) is providing
insights into pain mechanisms. Shingles pain is a combination of normal and
neuropathic pain that reflects acute tissue and neural injury. PHN pain, which
lasts after tissues have healed, is caused by persistent neural injuries.
Spontaneous C-nociceptor activity has been documented in painful polyneuropathies
and probably occurs in shingles as well, although there are no microneurographic 
studies of either shingles or PHN. It is uncertain if this persists in PHN since 
pathological examination of PHN-affected nerves and ganglia show chronic neuronal
loss and quiescent scarring without inflammation. Skin-biopsy study has
correlated the presence of PHN with the severity of persistent distal nociceptive
axon loss, and autopsy has correlated pain persistence with segmental atrophy of 
the spinal cord dorsal horn, highlighting the importance of central responses to 
nerve injury. Pathological studies of tissues from patients with trigeminal
neuralgia suggest that brief lancinating pains reflect ephaptic neurotransmission
between adjacent denuded axons. The mechanisms of chronic spontaneous pain and
mechanical allodynia remain uncertain despite considerable indirect evidence from
animal models. Postherpetic itch is presumably caused by unprovoked firing of the
peripheral and/or central neurons that mediate itch. If it occurs in neurons
innervating skin left severely deafferented from shingles ("numb"), patients can 
give themselves painless injuries from scratching. Further human study, by
electrophysiological recording, by structural and functional imaging, and by
autopsy, should continue to provide much-needed insights. PERSPECTIVE: Many
patients continue to have chronic pain and/or itch after shingles that is
unrelieved by current treatments. Many will gladly volunteer for clinical
studies, including autopsy, to try and improve understanding of these common and 
disabling conditions. Their prevalence makes highly powered studies feasible.
Funding and organization are the current bottlenecks.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18166461 [PubMed - in process]

32: J Pain. 2008 Jan;9(1 Suppl 1):S3-9.

Natural history and treatment of herpes zoster.

Schmader KE, Dworkin RH.

Division of Geriatrics, Department of Medicine, Duke University Medical Center
and Geriatric Research, Education and Clinical Center, Durham VA Medical Center, 
Durham, NC 27705, USA. schma001@mc.duke.edu

The objective of this article is to provide an overview of the natural history
and treatment of herpes zoster, with a focus on pain management. Herpes zoster
has the highest incidence of all neurological diseases, occurring annually in
approximately 1 million people in the United States. A basic feature of herpes
zoster is a marked increase in incidence with aging and with diseases and drugs
that impair cellular immunity. Herpes zoster begins with reactivation of
varicella zoster virus in dorsal root or cranial nerve ganglia, which is often
accompanied by a prodrome of dermatomal pain or abnormal sensations. Varicella
zoster virus spreads in the affected primary afferent nerve to the skin and
produces a characteristic dermatomal maculopapular and vesicular rash and pain.
Herpes zoster acute pain lowers quality of life and interferes with activities of
daily living. Antiviral therapy and scheduled analgesics form the
pharmacotherapeutic foundation for herpes zoster acute pain reduction. If
moderate to severe herpes zoster pain is not adequately relieved by antiviral
agents in combination with oral analgesic medications, then corticosteroids,
anticonvulsants (eg, gabapentin or pregabalin), tricyclic antidepressants (eg,
nortriptyline or desipramine), or neural blockade can be considered. PERSPECTIVE:
This article presents information on the clinical features and treatment of
herpes zoster. This information will help clinicians diagnose and manage herpes
zoster pain.

PMID: 18166460 [PubMed - in process]

33: Swiss Med Wkly. 2008 Jan 26;138(3-4):47-51.

Serology and serum DNA detection in shingles.

Dobec M, Bossart W, Kaeppeli F, Mueller-Schoop J.

Medizinische Laboratorien Dr. F. Kaeppeli, Zurich, Switzerland.
m.dobec@medica-labor.ch

AIM: To investigate the sensitivity of various laboratory approaches in the
diagnosis of herpes zoster from patient serum. METHODS: Paired sera from 53
consecutive adult patients with acute herpes zoster were tested for the presence 
of varicella-zoster virus (VZV) antibodies. All acute sera were tested
subsequently by real-time polymerase chain reaction (PCR) for the presence of VZV
DNA. In addition, convalescent sera of patients who tested initially positive for
VZV DNA underwent PCR analysis. RESULTS: VZV IgM antibodies were found by enzyme 
immunoassay (EIA) in 5 acute (9%) and 20 convalescent (38%) zoster sera. VZV DNA 
was detected by PCR in 21 (40%) acute zoster sera and was no longer detectable in
the convalescent samples. A seroconversion or a fourfold or greater titre
increase was found by complement fixation (CF) test in 41 (77%), by IgG indirect 
fluorescent antibody assay (IgG IFA) in 43 (81%) and by CF and IgG IFA combined
in 45 of 53 (85%) paired zoster sera. The combination of all serological methods 
detected 51 (96%) and PCR combined with serology identified 52 (98%) of 53
patients. CONCLUSIONS: Optimal laboratory sensitivity in the diagnosis of herpes 
zoster from serum can be achieved by the combination of PCR and serology of
paired serum samples. Serological methods alone are of limited value for early
diagnosis of zoster when therapy can be initiated, because CF and IgG IFA need
convalescent serum and IgM test sensitivity is insufficient. Early diagnosis of
VZV reactivation is possible from serum by PCR in the first days of illness and
test sensitivity needs further improvement. The findings highlight the need for
future studies into the usefulness of PCR and serology in atypical cases of VZV
reactivation.

PMID: 18224496 [PubMed - in process]

34: Adv Ther. 2008 Jan 17 [Epub ahead of print]

Prolactin levels and examination with breast ultrasound or mammography.

Sarac F, Tutuncuoglu P, Gokhan Ozgen A, Saygili F, Yilmaz C, Bilgen I, Memis A.

Department of Endocrinology and Metabolism, Ege University Hospital, 5th floor,
Bornova, Izmir, 35100, Turkey, fuldensarac@yahoo.com.

Objective: Stresses including surgery, exercise, nipple stimulation, and chest
wall injury such as mechanical trauma, burns, surgery, herpes zoster of thoracic 
dermatomes, hypoglycaemia and acute myocardial infarction cause significant
elevation of prolactin levels. The aim of the present study was to evaluate the
changes in prolactin level during mammography and ultrasonographic examination.
Materials and Methods: Seventy-four premenopausal (mean age, 32.1+/-7.3 y) and 81
post-menopausal women (mean age, 48.3+/-8.9 y) were enrolled into the study.
Premenopausal women were evaluated with ultrasound (Senographe 600 T [General
Electric]) and post-menopausal women were examined with mammography (Mammomat
3000 [Siemens]). Blood samples for prolactin were taken prior to ultrasound or
mammography and 15, 30 and 45 min after ultrasound or mammography. Results: Mean 
baseline serum prolactin level was 7.2+/-0.9 ng/ml in premenopausal women before 
ultrasound. Mean baseline serum prolactin level was 5.4+/-0.4 ng/ml in
post-menopausal women before mammography. It was found that there were no
significant changes in prolactin levels after ultrasound or mammography (P>0.05).
Mean levels of baseline prolactin were statistically significant higher in
premenopausal than in post-menopausal women (P=0.03). Conclusion: Mammography and
ultrasonographic examination have no acute effect on serum prolactin levels in
either group. There is no need to wait before measuring the prolactin level after
mammographic or ultrasonographic breast examination.

PMID: 18224292 [PubMed - as supplied by publisher]

35: Acta Ophthalmol Scand. 2008 Jan 24 [Epub ahead of print]

Central nervous system involvement after herpes zoster ophthalmicus.

Haargaard B, Lund-Andersen H, Milea D.

Department of Ophthalmology, Glostrup University Hospital, Copenhagen, Denmark.

Purpose: To report central nervous system involvement after varicella zoster
virus infection. Methods: We evaluated the frequency and type of neurological
complications in patients initially presenting with ophthalmic herpes zoster at
an ophthalmological department in a Danish university hospital, over a 7-year
period. Results: Of the 110 immunocompetent patients who presented with initial
ophthalmic zoster, six (5.5%) suffered from neurological complications other than
post-herpetic neuralgia. Four experienced isolated cranial motor nerve palsies,
one patient had meningitis with a favourable outcome and one patient had severe
encephalitis with a poor clinical outcome. Conclusions: Central nervous system
involvement after varicella zoster virus infection is an uncommon, but
potentially life-threatening, complication. Early recognition of neurological
complications prompts acute, appropriate antiviral treatment.

PMID: 18221497 [PubMed - as supplied by publisher]

36: Jpn J Infect Dis. 2008 Jan;61(1):65-7.

Molecular characterization of clinical varicella-zoster strains from India and
differentiation from the oka vaccine strain.

Kaushik KS, Lahiri KK, Chumber SK, Gupta RM, Kumar S, Kapila K, Karade S.

Department of Microbiology, Armed Forces Medical College, Pune, India.
mahakaroo@yahoo.com

With the introduction of varicella vaccination in India, surveillance of
circulating varicella-zoster strains has gained significance. The aim of the
present study was to achieve molecular characterization of circulating
varicella-zoster virus (VZV) strains and differentiation from the Oka vaccine
strain. In this study, the genotype of 100 clinical VZV strains was analyzed.
Vesicle fluid was collected from patients with VZV infections (92 cases of
varicella and 8 cases of herpes zoster). The PCR-RFLP analysis of two polymorphic
loci--a PstI restriction site in ORF 38 and a BglI restriction site in ORF 54 was
used to characterize and differentiate them from the vaccine strain. All the
wild-type strains were positive for the PstI restriction site in ORF 38. This
differentiated them from the Oka vaccine strain, which is PstI negative. The
wild-type strains as well as the Oka vaccine strain were positive for the BglI
restriction site in ORF 54. Thus, the genotype of all the VZV strains examined
had the wild-type pattern represented as PstI(+) BglI(+). None of the strains had
the PstI(-) BglI(+) genotype characteristic of the Oka strain or the PstI(+)
BglI(-) wild-type pattern. To conclude, PstI and BglI serve as good reference
markers in the genotyping of circulating varicella strains in India and serve to 
differentiate them from the vaccine strain as well as other wild-type strains.

PMID: 18219137 [PubMed - in process]

37: Am Fam Physician. 2007 Dec 15;76(12):1757.

Coping with the pain.

Wellbery C.

wellberc@georgetown.edu

Publication Types: 
    Case Reports

PMID: 18217515 [PubMed - indexed for MEDLINE]

38: Ig Sanita Pubbl. 2007 Mar-Apr;63(2):191-5.

[Is it possible to prevent herpes zoster through vaccination?]

[Article in Italian]

Franco E, Zaratti L, Ambrosini-Spinella S.

Dipartimento di Sanita Pubblica, Universita Tor Vergata, Roma.

The annualized incidence of herpes zoster, due to the endogenous reactivation of 
varicella zoster virus (VZV), varies between 2 and 5 cases per 1,000 persons with
a clear increase over 60 years of age. Mass vaccination against varicella in
infants could decrease natural boosters with an increase in zoster incidence.
Efficacy of a high titre VZV vaccine in preventing zoster and its sequelae was
demonstrated in a multicentric study on over 38.000 older adults. The
availability of a specific anti zoster vaccine, recently approved by FDA, could
offer an important tool to reduce health problems and improve quality of life in 
the elderly.

Publication Types: 
    English Abstract

PMID: 18216893 [PubMed - in process]

39: J Virol Methods. 2008 Mar;148(1-2):197-204. Epub 2008 Jan 22.

A highly efficient protocol of generating and analyzing VZV ORF deletion mutants 
based on a newly developed luciferase VZV BAC system.

Zhang Z, Huang Y, Zhu H.

Department of Microbiology and Molecular Genetics, UMDNJ-New Jersey Medical
School, 225 Warren Street, Newark, NJ 07101, United States.

Varicella Zoster Virus (VZV) is the causative agent for both varicella (chicken
pox) and herpes zoster (shingles). As a member of the human herpesvirus family,
VZV contains a large DNA genome, encoding 70 unique open reading frames (ORFs).
The functions of the majority of these ORFs remain unknown. Recently, the
full-length VZV (P-Oka strain) genome was cloned as a VZV bacteria artificial
chromosome (BAC) and additionally a firefly luciferase cassette was inserted to
generate a novel luciferase VZV BAC. In this study, a highly efficient protocol
has been developed exploiting the new luciferase VZV BAC system to rapidly
isolate and characterize VZV ORF deletion mutants by growth curve analysis in
cell culture.

PMID: 18215429 [PubMed - in process]

40: Ann Emerg Med. 2008 Feb;51(2):211, 219.

Images in emergency medicine. Herpes zoster ophthalmicus with ocular involvement.

Hahn B, Arnold N, Roth N.

Department of Emergency Medicine, Staten Island University Hospital, Staten
Island, NY, USA.

Publication Types: 
    Case Reports

PMID: 18206556 [PubMed - indexed for MEDLINE]

41: N Engl J Med. 2008 Jan 17;358(3):306; author reply 307.

Comment on:
    N Engl J Med. 2007 Oct 18;357(16):1598-607.

Prednisolone or acyclovir in Bell's palsy.

Leiner S.

Publication Types: 
    Comment
    Letter

PMID: 18203331 [PubMed - indexed for MEDLINE]

42: N Engl J Med. 2008 Jan 17;358(3):306; author reply 307.

Comment on:
    N Engl J Med. 2007 Oct 18;357(16):1598-607.

Prednisolone or acyclovir in Bell's palsy.

Beutner D.

Publication Types: 
    Comment
    Letter

PMID: 18199872 [PubMed - indexed for MEDLINE]

43: Rev Neurol Dis. 2007 Fall;4(4):203-8.

Management of acute shingles (herpes zoster).

Tyler KL, Beckham JD.

University of Colorado Health Sciences Center, Denver, CO, USA.

Practical, evidence-based recommendations for the management of acute shingles
(herpes zoster) were published this year in Clinical Infectious Diseases. These
guidelines were the result of a consensus meeting of several groups with an
interest in neuropathic pain and varicella-zoster virus research. This article
summarizes the key findings and recommendations that were generated from this
meeting and reviews some of the research on which these guidelines are based.

Publication Types: 
    Review

PMID: 18195672 [PubMed - indexed for MEDLINE]

44: Neurologist. 2008 Jan;14(1):52-5.

Transient facial palsy in two cases of benign, very rare middle ear tumors
(carcinoid tumor and myxoma).

Zehlicke T, Punke C, Boltze C, Pau HW.

Department of Otorhinolaryngology, Head and Neck Surgery Otto Koerner, University
of Rostock, Rostock, Germany. thorsten.zehlicke@med.uni-rostock.de

OBJECTIVE: Presentation of the clinical features of 2 very rare middle ear tumors
in which the guiding symptom was facial palsy. MATERIAL AND METHODS: Illustrative
case reports about a myxoma and a carcinoid tumor of the middle ear associated
with peripheral facial palsy. RESULTS: The facial palsy was transient in either
case, and its pathomechanism is open for discussion. In both cases, the initial
symptoms were typical for an inflammatory process. Moreover, both tumor entities 
are typically found in organs other than the ear; if located in the middle ear,
those neoplasms grow rather superficially. In those cases, a surgical exposure of
the middle ear is indicated. CONCLUSION: The etiopathology of an acute peripheral
facial palsy is often hard to identify. If the facial weakness starts together
with symptoms suggesting an inflammatory process, the differential diagnosis may 
be focused first on diseases like herpes zoster oticus and a severe course of
acute purulent otitis media. We report the cases of 2 rare middle ear tumors
causing facial palsy. Treatment of choice should be complete surgical excision.

PMID: 18195660 [PubMed - in process]

45: Z Gastroenterol. 2008 Jan;46(1):45-7.

Postoperative fulminant varicella zoster virus hepatitis with fatal outcome: a
case report.

Drebber U, Preuss SF, Kasper HU, Wieland U, Dienes HP.

Institute of Pathology, University of Cologne, Cologne, Germany.
u.drebber@uni-koeln.de

INTRODUCTION: Fulminant hepatitis due to varicella zoster virus (VZV) infection
has a poor prognosis although an effective treatment is available. CASE REPORT:
We present a case of fulminant hepatic failure (FHF) as a result of disseminated 
VZV infection in a long-term alcoholic patient who underwent laryngectomy and
radical neck dissection due to squamous cell carcinoma of the larynx. Post-mortem
examination revealed the diagnosis of fulminant hepatitis and infection with VZV.
Viral inclusion bodies were found in the hypopharyngeal mucosa as well as in the 
liver tissue. In these tissues VZV was detected by PCR. The clinical presentation
is suggestive for a reactivation of VZV without cutaneous signs of herpes zoster 
during a state of immunosuppression. DISCUSSION: Differential diagnosis comprises
hepatitis by other Herpes group viruses and toxic hepatic injury.

PMID: 18188815 [PubMed - in process]

46: Kulak Burun Bogaz Ihtis Derg. 2007;17(5):287-9.

A case of herpes zoster presenting as orbital cellulitis.

Al-Rikabi A, Trotter MI, Khan H, Raut VV.

Head and Neck Department, Russells Hall Hospital, Dudley Group of Hospitals,
Dudley, UK. alikamil30@yahoo.com.

We presented an unusual case of ophthalmic herpes zoster masquerading as orbital 
cellulitis, resulting in delay in appropriate treatment. A 65-year-old woman
presented with left periorbital pain and swelling of a week duration. Examination
revealed periorbital edema and inflammation but no proptosis. The erythema
extended onto the brow. There was no change in visual acuity and cranial nerve
function was normal. She was apyrexial and all other parameters were within
normal limits. The patient was admitted with an initial diagnosis of sinusitis
with orbital cellulitis/dacryocystitis and intravenous co-amoxiclav and a
non-steroidal anti-inflammatory drug were administered. The following day, there 
was little change in her condition with the ocular movements being normal and
vision remaining unaffected. She was apyrexial but the periorbital swelling
persisted. Computed tomography of the sinuses did not show sinusitis or a
periorbital collection. The third day after admission and 10 days after the
initial appearance of pain, vesicles appeared on the left forehead, which enabled
a diagnosis of herpes zoster of the ophthalmic branch of the trigeminal nerve.
She was then treated with acyclovir with a good result.

PMID: 18187989 [PubMed - in process]

47: J Heart Lung Transplant. 2008 Jan;27(1):11-6.

Incidence and clinical characteristics of herpes zoster after lung
transplantation.

Manuel O, Kumar D, Singer LG, Cobos I, Humar A.

Department of Transplant Infectious Diseases, University of Alberta, Edmonton,
Alberta, Canada. o.manuel@provlab.ab.ca

BACKGROUND: Solid-organ transplant recipients are at high risk for the
development of herpes zoster. Epidemiologic data in lung transplant recipients
are lacking. We determined the incidence and clinical characteristics of herpes
zoster, and the risk factors for developing herpes zoster, after lung
transplantation. METHODS: We retrospectively reviewed all adult (>18 years old)
lung transplants performed at our institution between January 2001 and December
2005. Clinical characteristics of herpes zoster and potential risk factors
associated with herpes zoster were assessed. RESULTS: Two hundred thirty-nine
lung transplant recipients were included in the analysis. Median time of
follow-up was 722 days (range 18 to 1,943 days). Thirty-five episodes of herpes
zoster occurred in 29 patients, with a calculated incidence of 55.1 cases per
1,000 person-years of follow-up. The cumulative probability of herpes zoster was 
5.8% at 1 year, 18.1% at 3 years and 20.2% at 5 years post-transplant. Only 2 of 
the 35 (5.7%) patients had disseminated cutaneous infection and none had visceral
involvement. Recurrence of herpes zoster was seen in 13.8% of patients.
Post-herpetic neuralgia was detected in 20% of cases. Anti-viral prophylaxis,
primarily for cytomegalovirus (CMV), was protective against herpes zoster. No
significant epidemiologic risk factors associated with herpes zoster could be
identified. CONCLUSIONS: Herpes zoster is a common complication after lung
transplantation with a peak incidence at between 1 and 4 years post-transplant.
Preventive strategies would be beneficial for this population.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18187081 [PubMed - indexed for MEDLINE]

48: Cir Cir. 2007 Nov-Dec;75(6):491-7.

[Normal variants and frequent pitfalls with (18)FDG PET/CT study.]

[Article in Spanish]

Del Rocio Estrada-Sanchez G, Altamirano-Ley J, Ochoa-Carrillo FJ.

Unidad PET/CT, C.T. Scanner del Sur, Mexico, D.F., Mexico. dragiselaus@yahoo.com.

Background: Fluordeoxyglucose ((18)FDG) is the most common radiotracer used for
PET/CT studies. It enters the cell because of the glucose transporter proteins
(GLUTs): 1) erythrocytic membrane, skeletal muscle, lymphocytes, ovaries, breast;
2) pancreas, retina, erythrocytes; 3) adipocytes, ovaries, testis; 4) skeletal
muscle, adipocytes, ovaries, myocardium; 5) breast, small intestine, testis,
kidney, erythrocytes; 6) spleen, leucocytes, brain; 7) liver; 8) testis, brain;
9) liver, kidney; 10) liver, pancreas; 11) heart, muscle; 12) heart, prostate;
13) brain. Methods. We undertook this study to expand the knowledge about
physiological uptake. Physiological uptake of (18)FDG was in brain, Waldeyer ring
(adenoids, palatine tonsils, lingual tonsils), salivary glands (parotids,
submandibular), tongue, vocal cords, cricoarythenoid muscle, thyroid, brown fat
(supraclavicular, mediastinal, neck, pericardial fat, around kidney, around great
vessels in the thorax, subdiaphragmatic, intercostals, paravertebral),
myocardium, breast, thymus, contractive muscles, liver, spleen (similar to the
liver), stomach, intestine, kidneys, bladder, uterus, ovaries, testes, bone
marrow, esophagus, and atherosclerotic inflammatory plaque. Results: False
positives were as follows: pneumoniae, tuberculosis, sarcoidosis, cryptococcosis,
thrombosis, bronchitis, costochondritis, radiation pneumonitis, misregistration
for respiratory movements, catheters, thyroid and adrenal adenomas, osteophytes, 
fractures, abscess, foreign body, surgical wounds, ostomies, prosthesis,
degenerative joint diseases, osteomyelitis, amyloidosis, pancreatitis, myositis, 
gastritis, colitis, herpes zoster. (18)FDG should be injected 4-6 h after insulin
administration because it will be concentrated in the muscles. The brown fat
raises its uptake 50% in late images. Conclusions: It is vital to know the most
frequent sites of physiological uptake in the (18)FDG PET/CT studies to identify 
those regions that occasionally present hypermetabolism but that are not related 
to neoplastic tumors. This must be taken into consideration in the evaluation of 
PET/CT studies.

Publication Types: 
    English Abstract

PMID: 18177573 [PubMed - in process]

49: Pediatr Infect Dis J. 2008 Feb;27(2):112-8.

The epidemiology of children hospitalized with herpes zoster in Canada:
Immunization Monitoring Program, Active (IMPACT), 1991-2005.

Wootton SH, Law B, Tan B, Mozel M, Scheifele DW, Halperin S; IMPACT
Investigators.

University of British Columbia, Vancouver, British Columbia, Canada.

BACKGROUND: Varicella zoster virus causes varicella (chickenpox) and can
reactivate to cause herpes zoster (HZ). In Canada, live attenuated varicella
vaccine was recommended for routine use among healthy susceptible children age 1 
year and older, in 1999. Varicella vaccine has had a profound impact on the
incidence of varicella; however the impact on HZ remains uncertain. METHODS:
Surveillance for HZ admissions was conducted by the Immunization Monitoring
Program, Active (IMPACT) surveillance network comprising 12 centers representing 
over 90% of pediatric tertiary care beds in Canada. Active surveillance for HZ
was undertaken in 1991-1996 and reintroduced in 1999. A clinical diagnosis was
accepted, with or without laboratory confirmation. For each case, a detailed case
report form was completed. RESULTS: In total, 648 children were admitted with HZ;
342 (52.8%) were boys and the mean age was 9.9 +/- 4.4 years. Five hundred
seventy-seven (89.0%) were immunocompromised and 71 immunocompetent (10.8%). Five
hundred seventy-one (88.1%) had a history of varicella zoster virus infection.
Varicella vaccination was documented in 4 children before admission. Most (85.5%)
presented with localized disease. Immunocompetent children were more likely than 
immunocompromised children to be hospitalized with ophthalmic disease (odds ratio
5.1, P < 0.001) or with at least 1 complication (odds ratio 3.0, P < 0.001). Only
1 death was attributable to HZ. CONCLUSIONS: Immunocompromised children
represented the overwhelming majority of IMPACT hospitalized cases. Complications
directly resulting from HZ were common in immunocompetent children. As varicella 
vaccine use becomes more widespread, the IMPACT network will continue to play an 
important role in monitoring the changing epidemiology of HZ in children.

PMID: 18174867 [PubMed - in process]

50: Int J Dermatol. 2008 Jan;47(1):36-9.

Herpes zoster-associated voiding dysfunction in hematopoietic malignancy
patients.

Imafuku S, Takahara M, Uenotsuchi T, Iwato K, Furue M.

Division of Dermatology and Hematology, Hiroshima Red Cross and Atomic Bomb
Survivor's Hospital, and Department of Dermatology, Graduate School of Medical
Sciences, Kyushu University. dermatologist@mac.com

BACKGROUND: Voiding dysfunction is a rare but important complication of
lumbo-sacral herpes zoster. Although the symptoms are transient, the clinical
impact on immunocompromised patients cannot be overlooked. METHODS: To clarify
the time course of voiding dysfunction in herpes zoster, 13 herpes zoster
patients with voiding dysfunction were retrospectively analyzed. RESULTS: Of 13
patients, 12 had background disease, and six of these were hematopoietic
malignancies; four of these patients were hematopoietic stem cell transplant
(HSCT) recipients. Ten patients had sacral lesions, two had lumbar, and one had
thoracic lesions. Interestingly, patients with severe rash, or with hematopoietic
malignancy had later onset of urinary retention than did patients with mild skin 
symptoms (Mann-Whitney U analysis, P = 0.053) or with other background disease (P
= 0.0082). Patients with severe skin rash also had longer durations (P = 0.035). 
In one case, acute urinary retention occurred as late as 19 days after the onset 
of skin rash. CONCLUSIONS: In immune compromised subjects, attention should be
paid to patients with herpes zoster in the lumbo-sacral area for late onset of
acute urinary retention even after the resolution of skin symptoms.

PMID: 18173598 [PubMed - in process]

51: Can Commun Dis Rep. 2007 Nov 1;33(11):1-15.

The burden of varicella and zoster in British Columbia 1994-2003: baseline
assessment prior to universal vaccination.

[Article in English, French]

Edgar BL, Galanis E, Kay C, Skowronski D, Naus M, Patrick D.

Epidemiology Services, BC Centre for Disease Control, Vancouver, British
Columbia, Canada.

PMID: 18163240 [PubMed - indexed for MEDLINE]

52: MMW Fortschr Med. 2007 Nov 29;149(48):60.

[Chickenpox misjudged for a long time. No real pustules, but still very dangerous
]

[Article in German]

Gerardy KF.

Publication Types: 
    Historical Article

PMID: 18161440 [PubMed - indexed for MEDLINE]

53: Arq Bras Oftalmol. 2007 Sep-Oct;70(5):767-70.

[Ophthalmologic findings in cardiac transplant recipients]

[Article in Portuguese]

Pires CS, de Aguiar Remigio MC, de Aguiar MI, Tenorio D, Moraes CR, de Olinda
Cavalcanti HD.

Fundacao Altino Ventura, Recife, PE, Brazil. fav@fundacaoaltinoventura.org.br

PURPOSE: To evaluate findings of ophthalmologic examinations in cardiac
transplant recipients, searching especially for changes in the retinal nerve
fiber layer by means of Scanning Laser Polarimetry. METHODS: Fifteen cardiac
transplant recipients were examined from September 2003 to July 2004. All of them
underwent ophthalmologic examination, which consisted of visual acuity (VA),
biomicroscopy, tonometry and fundoscopy. Fiber layer analyzer-GDx-examination was
performed in eleven patients. Twelve patients were men. The mean age was
55.0+/-13.5 years. The follow-up since transplantation lasted from 3 to 74
months; mean value 29.7+/-20.8 months. RESULTS: VA with best correction in all
patients attained at least 20/40. Subcapsular posterior cataract was seen in one 
patient; another presented corneal nubeculae secondary to herpes zoster. In one
case a scar suggesting retinocoroiditis was seen at fundoscopy. Biomicroscopic
and the fundoscopic findings were expected because of immunosuppressive
treatment, following transplantation. GDx examination disclosed loss of fibers in
the superior retinal fiber layer in 12 of the 22 examined eyes. CONCLUSION: These
results support the hypothesis that reduction of oxygen inflow in retinal
circulation before or during heart transplantation could lead to loss of fibers
in the retinal nerve fiber layer.

Publication Types: 
    English Abstract

PMID: 18157299 [PubMed - in process]

54: BMJ. 2007 Dec 22;335(7633):1305.

Death delusion.

Hellden A, Odar-Cederlof I, Larsson K, Fehrman-Ekholm I, Linden T.

Division of Clinical Pharmacology/Pharmacovigilance, Department of Laboratory
Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm,
Sweden. anders.hellden@ki.se

Publication Types: 
    Case Reports

PMID: 18156240 [PubMed - indexed for MEDLINE]

55: J Ark Med Soc. 2007 Dec;104(6):139.

An unusual case of shingles.

Dildy DW Jr, McLeane LR.

Publication Types: 
    Case Reports

PMID: 18092499 [PubMed - indexed for MEDLINE]

56: Laryngoscope. 2007 Dec 3 [Epub ahead of print]

Prognostic Value of Electroneurography and Electromyography in FacialPalsy.

Grosheva M, Wittekindt C, Guntinas-Lichius O.

From the Department of Otorhinolaryngology, Head and Neck Surgery (M.G.),
University of Cologne, Cologne, Germany; and the Department of
Otorhinolaryngology (c.w.; o.g.-l.), Friedrich-Schiller-University, Jena,
Germany.

OBJECTIVES:: To compare the prognostic value of electroneurography (ENG) and
needle electromyography (EMG) to estimate facial function outcome after acute
facial palsy. STUDY DESIGN:: Retrospective study using electrodiagnostic data and
medical chart review. METHODS:: Two hundred one patients treated 1995 to 2004
were included. Initial and final facial function was established clinically by
the House-Brackmann (HB) scale. ENG results were classified into amplitude loss
less than 75% and amplitude loss 75% or greater to predict complete recovery and 
defective healing, respectively. Initial and follow-up EMG results were
classified into neurapraxia and predicted complete recovery. In contrast,
axonotmesis/neurotmesis and mixed lesions predicted, by definition, defective
healing. RESULTS:: Initial HB was II to IV in 154 patients and V to VI in 47
patients. The etiology was idiopathic palsy in 139, iatrogenic lesion in 29,
traumatic in 18, and herpes zoster in 15 patients. Finally, 134 (67%) patients
showed a full recovery. Sixty-seven (33%) patients showed signs of defective
healing. ENG presented a sensitivity, specificity, accuracy, positive predictive 
value (to predict defective healing), and negative predictive value of 60%, 79%, 
73%, 59%, and 80%, respectively. The values for the initial EMG were 66%, 98%,
89%, 91%, and 89%. The best results showed the follow-up EMG with 85%, 100%, 97%,
100%, and 96%. EMG results were not classifiable in 32 (16%) patients.
CONCLUSIONS:: EMG showed higher prognostic values than ENG, especially when
repeated during the time course of the facial palsy. ENG might be helpful if the 
EMG result is not classifiable.

PMID: 18090862 [PubMed - as supplied by publisher]

57: Arch Dermatol. 2007 Dec;143(12):1599-600.

A case of zosteriform pigmented purpuric dermatosis.

Hamada T, Inoue Y, Nakama T, Hashimoto T.

Publication Types: 
    Case Reports
    Letter
    Research Support, Non-U.S. Gov't

PMID: 18087025 [PubMed - indexed for MEDLINE]

58: Pediatrics. 2008 Jan;121(1):e150-6. Epub 2007 Dec 17.

Primary varicella and herpes zoster among HIV-infected children from 1989 to
2006.

Wood SM, Shah SS, Steenhoff AP, Rutstein RM.

Special Immunology Service, Children's Hospital of Philadelphia, 34th Street and 
Civic Center Boulevard, Philadelphia, PA 19104, USA.

OBJECTIVES: The primary objective of this study was to determine the incidence of
herpes zoster in perinatally HIV-infected children. Secondary objectives included
assessing the impact of highly active antiretroviral therapy and varicella zoster
virus immunization on primary varicella and herpes zoster incidence and
identifying risk factors for herpes zoster. We hypothesized that the incidence of
herpes zoster has decreased in this population as a result of highly active
antiretroviral therapy and routine varicella zoster virus immunization. PATIENTS 
AND METHODS: This retrospective cohort study included HIV-infected children at a 
pediatric HIV clinic from 1989 to 2006. Incidence rates for 3 intervals
(1989-1996, 1997-1999, and 2000-2006) were compared on the basis of introduction 
of highly active antiretroviral therapy (1996) and varicella zoster virus
vaccination (1999). A Cox proportional-hazards regression model was developed for
the time to herpes zoster among the subset of patients with primary varicella
infection. RESULTS: In 356 patients followed for 1721 person-years, the incidence
of herpes zoster according to period was 30.0 per 1000 person-years in 1989-1996,
31.9 per 1000 person-years in 1997-1999, and 6.5 per 1000 person-years in
2000-2006. There was no difference in incidence-rate ratio between 1989-1996 and 
1997-1999. However, there was a significant difference in herpes zoster incidence
when comparing 1989-1999 with 2000-2006. The incidence of primary varicella
zoster virus infection and herpes zoster in the 57 patients who received the
varicella zoster virus vaccine was 22.3 per 1000 and 4.5 per 1000 person-years,
respectively. Highly active antiretroviral therapy at the time of primary
varicella zoster virus infection was protective against herpes zoster and
increased herpes zoster-free survival. CONCLUSIONS: The incidence of herpes
zoster has decreased since 1989. The decline occurred after 2000, likely
representing the combined effect of immunization and highly active antiretroviral
therapy. The use of highly active antiretroviral therapy at the time of primary
varicella zoster virus infection decreased the risk of herpes zoster and
increased herpes zoster-free survival. Varicella zoster virus immunization was
effective in preventing both primary varicella zoster virus and herpes zoster in 
this cohort.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18086820 [PubMed - indexed for MEDLINE]

59: Transpl Infect Dis. 2007 Dec 11 [Epub ahead of print]

Varicella zoster virus-associated disease in adult kidney transplant recipients: 
incidence and risk-factor analysis.

Arness T, Pedersen R, Dierkhising R, Kremers W, Patel R.

Mayo Medical School, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, 
Minnesota, USA.

Varicella zoster virus (VZV)-related disease, particularly herpes zoster, is a
complication of organ transplantation due to long-term immunosuppression. We
determined the incidence and risk factors for post-transplant VZV infection by
retrospectively reviewing the medical records of a cohort of 612 adult renal
transplant recipients transplanted at Mayo Clinic Rochester between October 1,
2001 and October 1, 2004. Thirty-seven subjects developed herpes zoster,
corresponding to a follow-up time-adjusted incidence of 11.2% at 4 years post
transplant. The incidence rate of zoster was relatively constant between 6 months
and 4 years, yielding an average incidence of approximately 28 per 1000
person-years. The risk of developing post-transplant zoster increased with
increasing age at transplant, with each decade conferring a 1.42-fold (P=0.009)
increase in risk of zoster development. Seronegativity at time of transplant
conferred over 3 times the risk of development of post-transplant zoster (hazard 
ratio 3.4; P=0.04) compared with seropositivity. Adult kidney transplant
recipients are at high risk for the development of post-transplant zoster.

PMID: 18086277 [PubMed - as supplied by publisher]

60: Ocul Immunol Inflamm. 2007 Nov-Dec;15(6):425-7.

Long-term preservation of vision in progressive outer retinal necrosis treated
with combination antiviral drugs and highly active antiretroviral therapy.

Kim SJ, Equi R, Belair ML, Fine HF, Dunn JP.

The Johns Hopkins Hospital, The Wilmer Eye Institute, Ophthalmology, Baltimore
21205, USA.

PURPOSE: To report the successful long-term treatment of varicella zoster
virus-associated progressive outer retinal necrosis (VZV-PORN) with aggressive
antiviral combination drugs along with highly active antiretroviral therapy
(HAART). DESIGN: Interventional case report. METHODS: Combined treatment of
progressive outer retinal necrosis in a university-based tertiary eye hospital
with ganciclovir implant, intravenous acyclovir (10 mg/kg every 8 h),
intravitreal foscarnet (2.4 mg), and HAART. RESULTS: Successful treatment of
progressive outer retinal necrosis with disease remission and preservation of
20/20 visual acuity out to 1 year. CONCLUSIONS: Combination antiviral therapy and
HAART may improve long-term visual outcomes for VZV-PORN.

Publication Types: 
    Case Reports

PMID: 18085485 [PubMed - indexed for MEDLINE]

61: Blood. 2008 Feb 15;111(4):1848-54. Epub 2007 Dec 13.

A phase 1 multidose study of SGN-30 immunotherapy in patients with refractory or 
recurrent CD30+ hematologic malignancies.

Bartlett NL, Younes A, Carabasi MH, Forero A, Rosenblatt JD, Leonard JP,
Bernstein SH, Bociek RG, Lorenz JM, Hart BW, Barton J.

Phase 1 testing of SGN-30, a chimeric monoclonal antibody for the treatment of
CD30(+) malignancies, was conducted in a multicenter study. To explore the safety
profile and establish the maximum tolerated dose (MTD), 24 patients with
refractory or relapsed Hodgkin lymphoma or CD30(+) non-Hodgkin lymphoma received 
6 weekly doses of intravenous SGN-30 at 4 dose levels (2, 4, 8, or 12 mg/kg).
Serum concentrations of SGN-30 rose rapidly and were dose dependent. Adverse
events were mild, with nausea, fatigue, and fever attributed to study treatment. 
One episode of hypersensitivity rash was reported. The MTD was not reached.
Serious adverse events included herpes zoster (n = 2), influenza, and pneumonia. 
One patient with cutaneous anaplastic large cell lymphoma (8 mg/kg) achieved a
complete response. Six patients, of whom 4 had Hodgkin lymphoma, achieved stable 
disease with durations ranging from 6 to 16 months. The pharmacokinetic profile
of SGN-30 showed a biphasic disposition, and estimated half-lives ranging between
1 to 3 weeks. The 6 weekly infusions of SGN-30 resulted in approximately 2- to
3-fold accumulation in serum exposures consistently across the dose range. These 
results demonstrate that weekly administration of SGN-30 is safe and has modest
clinical activity in patients with CD30(+) tumors. This trial is registered at
http://www.ClinicalTrials.gov as no. NCT00051597.

PMID: 18079362 [PubMed - in process]

62: Clin Vaccine Immunol. 2008 Feb;15(2):314-9. Epub 2007 Dec 12.

A double-blind, randomized, controlled, multicenter safety and immunogenicity
study of a refrigerator-stable formulation of Zostavax.

Gilderman LI, Lawless JF, Nolen TM, Sterling T, Rutledge RZ, Fernsler DA, Azrolan
N, Sutradhar SC, Wang WW, Chan IS, Schlienger K, Schodel F, Silber JL; Zostavax
Protocol 010 Study Group.

University Clinical Research, Pembroke Pines, Florida, USA.

The vaccine Zostavax has been shown to prevent herpes zoster (HZ) and
postherpetic neuralgia and is recommended for individuals > or =60 years of age. 
This study compared the safety and the immunogenicity of a refrigerator-stable
formulation (Zostavax refrigerated) with those of the current formulation
(Zostavax frozen) in subjects > or =50 years of age. Subjects with a negative
history for HZ were randomized 1:1 to receive one dose of either formulation.
Enrollment was stratified 1:2 by age (50 to 59 years and > or =60 years). Safety 
was evaluated for 28 days postvaccination. Varicella-zoster virus (VZV) antibody 
responses were measured by a glycoprotein enzyme-linked immunosorbent assay
(gpELISA). The primary endpoints were the VZV antibody geometric mean titer (GMT;
day 28), the VZV antibody geometric mean rise (GMR; days 1 to 28), and the
incidence of vaccine-related serious adverse experiences (AEs) over 28 days. The 
refrigerated (n = 182) and frozen (n = 185) formulations induced similar GMTs
(727.4 and 834.4 gpELISA units/ml, respectively); the estimated GMT ratio
(refrigerated formulation/frozen formulation) was 0.87 (95% confidence interval, 
0.71 to 1.07). The GMRs were 2.6- and 2.9-fold, respectively. No vaccine-related 
serious AEs were reported in either group, and the safety profiles of the
formulations were generally similar. The frequencies of injection-site AEs during
follow-up were 35.6% and 46.4% in the refrigerated and the frozen formulation
groups, respectively, and were generally mild. The frequencies of systemic AEs
were similar in the two groups, and those of vaccine-related AEs were
approximately 6% in both groups. The refrigerator-stable formulation of Zostavax 
has an acceptable safety profile and is as immunogenic as the frozen formulation;
thus, the vaccine may be used in clinical settings where freezer availability is 
limited.

PMID: 18077611 [PubMed - in process]

63: Nippon Rinsho. 2007 Oct 28;65 Suppl 8:233-41.

[Adverse effects of antiviral agents]

[Article in Japanese]

Moriuchi M, Moriuchi H.

Department of Molecular Microbiology and Immunology, Nagasaki University Graduate
School of Biomedical Sciences.

Publication Types: 
    Review

PMID: 18074544 [PubMed - indexed for MEDLINE]

64: Nephrol Dial Transplant. 2007 Dec 8 [Epub ahead of print]

Mycophenolate Mofetil Versus Cyclophosphamide for Inducing Remission of ANCA
Vasculitis with Moderate Renal Involvement.

Hu W, Liu C, Xie H, Chen H, Liu Z, Li L.

1Research Institute of Nephrology, Jingling Hospital.

Objective. We performed a single-centre non-blinded clinical trial to compare the
clinical efficacies of mycophenolate mofetil (MMF) and intermittent
cyclophosphamide (CTX) pulse therapy as induction treatments in patients with
antineutrophil cytoplasmic antibody (ANCA) vasculitis (AAV) and moderate renal
involvement. Methods. Patients with active AAV and serum creatinine <500 mumol/L 
received either MMF treatment (MMF group) or monthly CTX pulse therapy (CTX
group) for 6 months. Disease activity was assessed using the Birmingham
Vasculitis Activity Score (BVAS). The disease activity, remission rate, renal
function and adverse reactions were compared between the two groups. Results. A
total of 35 patients (15 male, 20 female: aged 49.1 +/- 12.2 years) were
enrolled, with 18 in the MMF group and 17 in the CTX group. Of the 35 patients,
28 were MPO-ANCA positive and 2 were PR3-ANCA positive. Four patients were lost
to follow-up in the CTX group. At Month 6, BVAS scores were much lower in the MMF
group than in the CTX group (0.2 +/- 0.89 versus 2.6 +/- 1.7, P < 0.05). In the
intent-to-treatment analysis, 14 of 18 patients (77.8%) treated with MMF and 8 of
17 patients receiving CTX (47.1%) had complete remission with an absolute
difference of 30.7%. Eight of 18 patients (44.4%) in the MMF group and 2 of 17
patients (15.4%) in the CTX group recovered renal function. Serum ANCA decreased 
to normal in 41.7% of patients in the MMF group and in 16.7% in the CTX group.
Side effects in the MMF group were pneumonia (1), herpes zoster (1) and
gastrointestinal symptoms (2), and in the CTX group were leukocytopenia (1),
gastrointestinal distress (4) and pneumonia (1). Conclusion. Our study suggests
that MMF effectively ameliorates disease activity and considerably improves renal
function in patients with AAV. Further large-scale multicentre prospective
randomized controlled trials will be needed to confirm these findings.

PMID: 18065810 [PubMed - as supplied by publisher]

65: Can J Ophthalmol. 2007 Dec;42(6):881.

Macular optical coherence tomography findings in progressive outer retinal
necrosis.

Almony A, Dhalla MS, Feiner L, Shah GK.

Publication Types: 
    Case Reports
    Letter

PMID: 18059519 [PubMed - indexed for MEDLINE]

66: Ophthalmology. 2007 Dec;114(12):2367; author reply 2367-8.

Comment on:
    Ophthalmology. 2007 Feb;114(2):307-12.

Oral drugs for viral retinitis.

Garner HR, Latkany P.

Publication Types: 
    Comment
    Letter

PMID: 18054655 [PubMed - indexed for MEDLINE]

67: Mayo Clin Proc. 2007 Dec;82(12):1562-5.

66-year-old man with inarticulate speech.

Curtis KK, Vikram HR.

Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic,
Scottsdale, AZ, USA.

Publication Types: 
    Case Reports

PMID: 18053466 [PubMed - indexed for MEDLINE]

68: MMW Fortschr Med. 2007 Nov 8;149(45):5.

[Unexpected diagnosis in a child. Herpes zoster]

[Article in German]

Escher W.

Publication Types: 
    Case Reports

PMID: 18050590 [PubMed - indexed for MEDLINE]

69: Ann Otolaryngol Chir Cervicofac. 2007 Oct;124 Suppl 1:S74-83.

[Pain associated with craniofacial and cervical herpes zoster]

[Article in French]

George B, Lory C.

Service d'anesthesie-reanimation chirurgicale, unite d'evaluation et de
traitement de la douleur, hopital Saint-Louis, 75010 Paris, France.

Ophthalmological and cervical involvement of herpes zoster virus ranks second and
third, respectively, in terms of localization frequency. Involvement of the
cranial nerves is a particular sign of complications, notably ocular
complications, possibly compromising the visual or facial prognosis through
involvement of the VIIth nerve, which is responsible for facial paralysis. These 
types of involvement should be rapidly diagnosed and treated so as to limit these
complications. The pain associated with herpes zoster remains frequent and
difficult to treat, even if today the criteria for defining postzoster pain is
increasingly refined. Antalgic and antiviral treatment should be initiated early,
from the very first signs, to attempt to reduce the incidence of this postzoster 
pain. The risk factors, associated with the development of postzoster pain are
age over 50 years, the severity of the skin rash and the intensity of the acute
pain, and the existence of a prodromic pain phase before onset. The European
Federation of Neurological Societies has recently published guidelines on the
pharmacological treatments for postzoster pain. Nerve block treatments remain at 
a limited evidence level. Patients with postzoster pain should be managed by
teams specializing in pain management as soon as conventional treatments fail.

Publication Types: 
    English Abstract
    Review

PMID: 18047868 [PubMed - indexed for MEDLINE]

70: J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S143-7.

Vaccination strategies for the prevention of herpes zoster and postherpetic
neuralgia.

Betts RF.

Infectious Diseases Unit, University of Rochester School of Medicine and
Dentistry, Rochester, New York, USA. robert_betts@urmc.rochester.edu

Herpes zoster disease and its most common complication, postherpetic neuralgia,
are associated with significant morbidity in the elderly. The zoster vaccine
boosts cell-mediated immunity to varicella-zoster virus, the virus that causes
both varicella and herpes zoster. This vaccine has demonstrated the ability to
reduce the zoster-related burden of illness and the incidence of both zoster and 
postherpetic neuralgia in a randomized, controlled trial conducted in individuals
aged 60 years and older, an age group at increased risk of herpes zoster.
Widespread use of this vaccine could prevent as many as a quarter of a million
cases of zoster disease each year. The design and outcomes of the Shingles
Prevention Study, which examined the efficacy and safety of the vaccine, and the 
rationale for widespread immunization against varicella-zoster virus, are
presented here.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18021866 [PubMed - indexed for MEDLINE]

71: J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S136-42.

Management of herpes zoster and postherpetic neuralgia.

Tyring SK.

Department of Dermatology, The University of Texas, Houston, Texas, USA.
styring@ccstexas.com

Patients with herpes zoster experience severe pain and potential lasting
complications such as postherpetic neuralgia, ophthalmic disease/damage, and,
rarely, skin complications (eg, infection of rash area). Treatment for acute
zoster aims to accelerate healing, control pain, and, when possible, reduce the
risk of complications. Early intervention with antivirals can accelerate rash
healing, reduce rash severity, and reduce the risk of some complications. The
addition of corticosteroids to antiviral medication may further alleviate
short-term zoster pain, but is associated with an increased risk of serious
adverse effects, especially among older adults. If a patient does develop
postherpetic neuralgia, gabapentin, pregabalin, opioids, tricyclic
antidepressants, lidocaine patch 5%, and capsaicin may all be considered as
palliative treatments. For individuals with treatment-refractory postherpetic
neuralgia, nonpharmacologic approaches may be considered and a pain-management
specialist should be consulted. There is a need for more effective agents to
treat herpes zoster and postherpetic neuralgia.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18021865 [PubMed - indexed for MEDLINE]

72: J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S130-5.

Herpes zoster: epidemiology, natural history, and common complications.

Weinberg JM.

Clinical Research Center, Department of Dermatology, St. Luke's-Roosevelt
Hospital Center, and Columbia University College of Physicians and Surgeons, New 
York, New York 10025, USA. jmw27@columbia.edu

Herpes zoster is a disease associated with aging that can significantly impair
quality of life for affected individuals. Anyone infected with varicella
(chickenpox) virus in childhood is at risk for reactivation of dormant virus and 
the onset of zoster disease, although it occurs with increasing frequency in the 
elderly as a result of waning of cell-mediated immunity. The most common
complication of herpes zoster is postherpetic neuralgia, which can cause chronic 
and debilitating pain. Current treatments can decrease the severity of zoster
rash and pain but cannot prevent disease onset or completely eliminate the most
frequent symptoms. The zoster vaccine may help prevent the onset of herpes zoster
in the target population of those age 60 years and older. This summary reviews
the epidemiology, pathogenesis, natural history, and common symptoms of zoster
disease.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18021864 [PubMed - indexed for MEDLINE]

73: Arthritis Rheum. 2007 Dec 15;57(8):1431-8.

The risk of herpes zoster in patients with rheumatoid arthritis in the United
States and the United Kingdom.

Smitten AL, Choi HK, Hochberg MC, Suissa S, Simon TA, Testa MA, Chan KA.

Harvard School of Public Health, Boston, Massachusetts 02115, USA.

OBJECTIVE: To determine whether the incidence of herpes zoster is elevated in
patients with rheumatoid arthritis (RA) and whether herpes zoster is associated
with use of disease-modifying antirheumatic drugs (DMARDs) in patients with RA.
METHODS: Two retrospective cohort studies were conducted using data from a US
integrated managed care database (PharMetrics claims database) from 1998-2002 and
the UK General Practice Research Database (GPRD) between 1990-2001. Rates of
herpes zoster among patients with RA and randomly sampled non-RA patients were
compared. A nested case-control analysis was performed within each RA cohort to
examine the effect of current treatment on herpes zoster risk. RESULTS: A total
of 122,272 patients with RA from the PharMetrics database and 38,621 from the
GPRD were included. The adjusted hazard ratios of herpes zoster for patients with
RA compared with non-RA patients were 1.91 (95% confidence interval [95% CI]
1.80-2.03) in the PharMetrics database and 1.65 (95% CI 1.57-1.75) in the GPRD.
In the PharMetrics database, current use of biologic DMARDs alone was associated 
with herpes zoster (odds ratio [OR] 1.54, 95% CI 1.04-2.29), as was current use
of traditional DMARDs alone (OR 1.37, 95% CI 1.18-1.59). In the GPRD, current use
of traditional DMARDs was associated with herpes zoster (OR 1.27, 95% CI
1.10-1.48). In both data sources, use of oral corticosteroids was associated with
herpes zoster regardless of concomitant therapies. CONCLUSION: Data from 2 large 
databases suggested that patients with RA are at increased risk of herpes zoster.
Among patients with RA, DMARDs and/or use of oral corticosteroids appeared to be 
associated with herpes zoster.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18050184 [PubMed - indexed for MEDLINE]

74: Arch Phys Med Rehabil. 2007 Dec;88(12):1742-3; author reply 1743-4.

Comment on:
    Arch Phys Med Rehabil. 2007 Feb;88(2):255-8.

Safety of cervical transforaminal steroid injections.

Shankar H.

Publication Types: 
    Comment
    Letter

PMID: 18047902 [PubMed - indexed for MEDLINE]

75: Herpes. 2007 Sep;14 Suppl 2:52-5.

Factors affecting an economic model for zoster vaccination.

Fattore G.

Centre for Research on Healthcare Management (CERGAS), Bocconi University, Milan,
Italy. giovanni.fattore@unibocconi.it

Results from the recent Shingles Prevention Study indicate that zoster
vaccination can reduce the incidence and severity of herpes zoster and
post-herpetic neuralgia (PHN), raising the possibility of a widespread
vaccination programme. Such a programme would incur substantial costs, mandating 
the need for rigorous cost-effectiveness analyses prior to implementation.
Suitably robust analyses of the cost benefits of zoster vaccination, capturing
the duration of benefits and impact on quality of life resulting from
vaccination, are lacking. Any economic model would need to consider current
estimates of the economic burden of zoster and PHN in unvaccinated populations,
as well the predicted effects of zoster vaccination on health improvements (e.g. 
reductions in zoster and PHN morbidity, improved quality of life, incidence of
adverse effects), and costs for the health system and society at large (e.g.
reductions in healthcare costs, variations in the costs of administering the
vaccine) in different regions. Economic estimates of the burden of zoster and PHN
in unvaccinated populations are scarce, and further studies are needed to measure
the impact of these prevention strategies in different regions of the world.

PMID: 17939898 [PubMed - in process]

76: Herpes. 2007 Sep;14 Suppl 2:48-51.

Prevention strategies: experience of varicella vaccination programmes.

Patrick D.

University of British Columbia, Centre for Disease Control, Vancouver, BC,
Canada. david.patrick@bccdc.ca

Widespread immunization programmes have had a dramatic effect on the morbidity
associated with varicella in the USA; mortality has declined by 66% (from 0.41 to
0.14 deaths / million population) and the reduction in hospitalizations is at
least 4-fold (from 2.7 to 0.6/100,000 population) compared with the
pre-vaccination era. Although varicella outbreaks have occurred in vaccination
areas, these data may underestimate the true efficacy of the varicella vaccine,
and there is still the potential for two-dose programmes, which have not yet been
fully explored in the USA or Canada. Catch-up vaccination programmes have also
been regarded as an important approach in susceptible individuals, including
women of childbearing potential. Periodic exposure (boosts) to vaccines may
potentially help prevent the reactivation of herpes zoster and accumulation of
susceptibility in these at-risk groups. Pregnant women may also benefit from
prophylaxis with varicella zoster immunoglobulin (VZIG) or possibly with
aciclovir. Ongoing surveillance for the reactivation of herpes zoster and safety 
programmes are also highlighted as key recommendations.

PMID: 17939897 [PubMed - in process]

77: Herpes. 2007 Sep;14 Suppl 2:45-7.

Prevention strategies: herpes zoster, post-herpetic neuralgia and immunogenicity.

Levin MJ, Schmader K.

Section of Pediatric Infectious Diseases, Department of Pediatrics, University of
Colorado School of Medicine, Denver, CO 80262, USA. myron.levin@uchsc.edu

Herpes zoster is a common condition that can have a significant impact on quality
of life among older adults. A significant proportion of older subjects with
herpes zoster develop post-herpetic neuralgia (PHN), a chronic condition that is 
difficult to treat. The Shingles Prevention Study was a large-scale clinical
trial to determine the efficacy of a live, attenuated varicella zoster virus
(VZV) vaccine ('zoster vaccine') for preventing or attenuating herpes zoster in
subjects aged > or =60 years. A total of 38 546 subjects were given either zoster
vaccine or placebo. The burden of illness (pain severity-by-duration), incidence 
of herpes zoster, and PHN decreased by 61.1%, 51.3% and 66.5% (all P<0.001),
respectively, following vaccination. Vaccine efficacy was maintained for a 4-year
follow-up period. A sub-study of the vaccine trial evaluated VZV-specific
immunity in approximately 1200 vaccine or placebo recipients prior to
vaccination, at 3 months and annually for 3 years. VZV-specific cell-mediated
immunity (CMI) was boosted significantly by the zoster vaccine. This boost
remained substantially intact for the 3 years of follow-up. It is likely that the
vaccine-induced boost in VZV-specific CMI reversed the natural decline in these
responses that occurs as part of the ageing process, thereby protecting vaccine
recipients against herpes zoster and its complications.

PMID: 17939896 [PubMed - in process]

78: Herpes. 2007 Sep;14 Suppl 2:40-4.

Epidemiology and burden of herpes zoster and post-herpetic neuralgia in
Australia, Asia and South America.

Araujo LQ, Macintyre CR, Vujacich C.

Federal University of Sao Paulo, UNIFESP, Sao Paulo, SP, Brazil.
lara.mqaraujo@gmail.com

Following the development of a herpes zoster vaccine and the successful
introduction of widespread varicella vaccination in the USA, many countries are
considering similar vaccination programmes. However, before implementing such
programmes, it is important to describe the regional baselines of varicella and
herpes zoster epidemiology, both to aid the design of vaccination strategies and 
to observe trends after the introduction of vaccination. In many areas of the
world, this information is difficult to gather, and the epidemiology of herpes
zoster and post-herpetic neuralgia in these regions is poorly understood. In
Australia, available national data sources of varicella and herpes zoster,
including serological data, provide reliable estimates of disease and reveal
similar rates of incidence and complications to those in Europe and the USA.
However, the average age of infection in Australia is higher than in Europe and
in the USA. Epidemiological data from Asia and South America are scarce.
Unexpectedly for tropical countries, the incidences of herpes zoster in Asia and 
South America also appear to be comparable with those in Europe and the USA,
despite the delayed acquisition of varicella-zoster virus infection in Asia. In
Brazil, there is some evidence for higher than expected incidence rates for
herpes zoster in young adults. The epidemiology of herpes zoster in Asia and
South America suggests that recommendations on treatment and prevention from
Europe and the USA may be relevant to these countries.

PMID: 17939895 [PubMed - in process]

79: Herpes. 2007 Sep;14 Suppl 2:35-9.

Severe complications of herpes zoster.

Volpi A.

Department of Public Health, University of Rome Tor Vergata, Rome, Italy.
volpi@med.uniroma2.it

The usual presentation of herpes zoster is as a self-limiting vesicular rash,
often accompanied by post-herpetic neuralgia (PHN), its most common complication.
However, herpes zoster can give rise to other complications, many of which have
unusual presentations and serious sequelae. The incidence and burden of many of
these less common complications are poorly understood. Ocular complications of
ophthalmic zoster are relatively frequent but, with early antiviral therapy, need
not be sight-threatening. Delayed contralateral hemiparesis is a rare
complication of ophthalmic zoster that may present as stroke, temporally remote
from the zoster episode. Ramsay Hunt syndrome is caused by reactivation of
varicella zoster virus (VZV) involving the facial nerve; facial paralysis, ear
pain and vesicles in the ear are diagnostic. Facial paralysis in the absence of
vesicles may indicate zoster sine herpete, which can be mistaken for Bell's
palsy. Herpetic facial palsies may respond to combination therapy with an
antiviral plus steroid, but further research is needed to determine the benefit
of such treatments.

PMID: 17939894 [PubMed - in process]

80: Herpes. 2007 Sep;14 Suppl 2:30-4.

Zoster-associated pain: what is known, who is at risk and how can it be managed?

Johnson RW.

University of Bristol, Bristol, UK. r.w.johnson@bris.ac.uk

Herpes zoster episodes commence with a prodromal period of about 4 days with
symptoms including pain and malaise. This is followed by a rash lasting
approximately 2-4 weeks, with possible subacute herpetic neuralgia for up to 3
months, followed, in some patients, by a period of post-herpetic neuralgia (PHN) 
lasting months or possibly years. Severe acute pain is more likely in older
females and those with a prodrome or severe rash. Two separate mechanisms of PHN 
have been proposed: the first is that the excitability of primary afferent
neurons is increased after nerve damage, causing irritable nociceptors and
central sensitization, resulting in pain and allodynia; the second involves the
degeneration of nociceptive neurons, which leads to deafferentation with central 
hyperactivity, causing pain but without allodynia. Both mechanisms may co-exist
in an individual patient. Treatments for acute herpes zoster and PHN include
established antivirals, alone or in combination with steroids, analgesics and
neural blockade with local anaesthetics. Commonly used pain relief includes
acetaminophen/paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioid
analgesics, tricyclic antidepressants, gabapentin, pregabalin and topical
analgesics. Effective and long-lasting pain relief in herpes zoster and PHN
remains a largely unmet medical need.

PMID: 17939893 [PubMed - in process]

81: Herpes. 2007 Sep;14 Suppl 2:25-9.

Varicella zoster virus: natural history and current therapies of varicella and
herpes zoster.

Breuer J, Whitley R.

Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts,
UK. j.breuer@qmul.ac.uk

The natural history of varicella zoster virus (VZV) infection and the molecular
mechanisms of viral pathogenesis are incompletely understood. Although no animal 
model yet reproduces all aspects of VZV infection, recently developed models of
VZV infection, and the creation of genetically altered VZV recombinants, are
yielding new information about primary viraemia and latency. During viraemia,
T-cells transport VZV to the skin, where cell-free viral replication facilitates 
person-to-person spread and transmission to the neurons where latency is
established. The alternate viral pathways of lytic infection or latency appear to
be cell-type determined and involve both host and viral components. Antiviral
therapy for varicella is safe and efficacious, and as varicella in children is
usually mild, treatment is generally recommended only for adolescents and adults 
with varicella. Treatment is recommended for all individuals with herpes zoster, 
especially those aged over 50 years. For some varicella and zoster cases,
aciclovir, the original standard, is being replaced by valaciclovir and
famciclovir as preferred therapies. For herpes zoster, bromovinyl deoxyuridine
(brivudin) has been added to the list of treatment options for immunocompetent
individuals, but is contraindicated in patients with cancer. Antiviral therapy
will still have a role in the treatment of disease caused by VZV even after the
widespread implementation of vaccination programmes for both chickenpox and
herpes zoster.

PMID: 17939892 [PubMed - in process]

82: Herpes. 2007 Sep;14 Suppl 2:24.

Global strategies to prevent herpes zoster and its associated complications.

Johnson RW, Griffiths P.

Publication Types: 
    Editorial

PMID: 17939891 [PubMed - in process]

83: Arch Dis Child. 2007 Nov 26 [Epub ahead of print]

B-Cell depletion therapy for 19 patients with refractory systemic lupus
erythematosus.

Podolskaya A, Stadermann M, Pilkington C, Marks SD, Tullus K.

Great Ormond Street Hospital for Children, United Kingdom.

OBJECTIVE: B-cell dysregulation is involved in the development of childhood-onset
systemic lupus erythematosus (SLE). We present the safety and efficacy of B-cell 
depletion therapy in children with refractory SLE in the largest series in the
literature. METHODS: 19 children (89% female) with SLE, aged 6-16 (median 14)
years, treated with rituximab in a single centre were retrospectively reviewed.
British Isles Lupus Assessment Group (BILAG) index and biochemical,
haematological and immunological parameters were evaluated before and after
treatment, with the primary outcome assessed as normal results. Rituximab therapy
was used for acute life or organ threatening symptoms, or symptoms that had not
responded to standard treatment. The range of symptoms included lupus nephritis, 
cerebral lupus and severe general symptoms. Rituximab 750 mg/m2 was given
intravenously twice, usually within a 2-week period. Patients were followed up
for 6-38 (median 20) months. RESULTS: Rapid reduction of SLE disease activity was
observed within the first month, represented by reduction of BILAG scores (14 to 
6, P<0.005), improvement of renal function (estimated glomerular filtration rate 
of 54 to 68 ml/min/1.73m;2, P=0.07), immunological (complement C3: 0.46 to 0.83
G/L, P=0.02) and haematological (haemoglobin: 9.7 to 10.3 g/dl, P=0.04)
parameters. No serious side effects were observed, except for herpes zoster in
five cases. CONCLUSION: In our cohort of children, rituximab was safe and
effective when used in combination with standard immunosuppressive agents.
Randomised controlled studies are needed to further evaluate the safety and
efficacy of rituximab therapy.

PMID: 18039744 [PubMed - as supplied by publisher]

84: JAAPA. 2007 Nov;20(11):21-5.

Herpes zoster in 2007: treatment and prevention.

Friel FJ.

Idaho Army National Guard, USA.

Publication Types: 
    Review

PMID: 18035759 [PubMed - indexed for MEDLINE]

85: Reg Anesth Pain Med. 2007 Nov-Dec;32(6):533-5.

Bee stings--a remedy for postherpetic neuralgia? A case report.

Janik JE, Wania-Galicia L, Kalauokalani D.

Department of Anesthesiology and Pain, University of California Davis Medical
Center, Sacramento, CA, USA. james.janik@chw.edu

OBJECTIVE: This case report describes the effects of bee stings on painful
postherpetic neuralgia in a 51-year-old man. CASE REPORT: The patient was stung
by 3 bees in the distribution in which he had been experiencing postherpetic
neuralgia. One day after the bee stings, the patient's painful postherpetic
neuralgia was completely relieved, and the relief lasted for 1 and a half months.
Subsequently, the patient's pain returned, but at significantly less intensity
and frequency than what he had experienced prior to the bee stings. CONCLUSIONS: 
Bee venom and bee sting therapy have been shown to have both antinociceptive and 
anti-inflammatory properties, which may explain why the bee stings relieved the
patient's postherpetic neuralgia. Bee sting or bee venom therapy should be
further investigated as a potential treatment modality for postherpetic
neuralgia.

Publication Types: 
    Case Reports

PMID: 18035302 [PubMed - indexed for MEDLINE]

86: J Am Acad Dermatol. 2007 Dec;57(6):1102-3.

Ramsay Hunt syndrome: a case report with cranial nerve XII involvement.

Izumi AK, Kitagawa K.

Publication Types: 
    Case Reports
    Letter

PMID: 18021862 [PubMed - indexed for MEDLINE]

87: J Infect Dis. 2007 Nov 15;196(10):1455-8.

Immunocompetent children account for the majority of complications in childhood
herpes zoster.

Grote V, von Kries R, Rosenfeld E, Belohradsky BH, Liese J.

Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilian
University, Heiglhofstrasse 63, Munich, Germany. veit.grote@med.uni-muenchen.de

In a 2-year-long active surveillance conducted in all German pediatric hospitals,
the incidence of hospitalization because of herpes zoster and the clinical
picture of complications in children were assessed. Herpes zoster resulted in
hospitalization of 244 children, 78 of whom were considered to be
immunocompromised. Zoster ophthalmicus (n=29), meningoencephalitis (n=22), and
zoster oticus (n=23) (11 cases had Ramsay Hunt syndrome) accounted for 59% of all
complications (n=115). The incidence of hospitalization suggests that at least 1 
in every 100 children with herpes zoster is hospitalized and that at least 1 in
every 250 immunocompetent children with herpes zoster is hospitalized with
complications.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18008223 [PubMed - indexed for MEDLINE]

88: Expert Rev Neurother. 2007 Nov;7(11):1581-95.

Postherpetic neuralgia: epidemiology, pathophysiology and management.

Johnson RW, Wasner G, Saddier P, Baron R.

Bristol Royal Infirmary, University of Bristol, Bristol, UK.
r.w.johnson@bris.ac.uk

Postherpetic neuralgia (PHN) is a neuropathic pain syndrome and is the most
common complication of herpes zoster (HZ; shingles). PHN occurs mainly in HZ
patients 60 years of age and older, in particular in those suffering from more
severe acute pain and rash. Administration of antiviral drugs reduces the
duration of pain associated with HZ. The pathophysiology of PHN may be distinctly
different between patients with either reduced or increased skin sensitivity.
Therapy is with tricyclic drugs (e.g., nortriptyline), alpha 2 delta-ligands
(e.g., gabapentin) or opiates with adjunctive topical lidocaine or capsaicin.
Mechanism-based therapy is a desirable goal but so far proves elusive. The
incidence of HZ, and therefore that of PHN, is likely to increase as a result of 
greater longevity and increasing numbers of patients receiving treatment that
compromises cell-mediated immunity. A zoster vaccine for administration to adults
reduces the incidence of HZ and PHN, as well as the burden of illness associated 
with these conditions.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17997705 [PubMed - indexed for MEDLINE]

89: Clin Infect Dis. 2007 Dec 1;45(11):1527-9.

Comment on:
    Clin Infect Dis. 2007 May 15;44(10):1280-8.

Cost-effectiveness of herpes zoster vaccine: flawed assumptions regarding
efficacy against postherpetic neuralgia.

Brisson M, Pellissier JM, Levin MJ.

Publication Types: 
    Comment
    Letter

PMID: 17990240 [PubMed - indexed for MEDLINE]

90: Int J Dermatol. 2007 Nov;46(11):1177-9.

Comparison of the Tzanck test and polymerase chain reaction in the diagnosis of
cutaneous herpes simplex and varicella zoster virus infections.

Ozcan A, Senol M, Saglam H, Seyhan M, Durmaz R, Aktas E, Ozerol IH.

Department of Dermatology, Inonu University School of Medicine, Malatya, Turkey.

Background: Although the diagnosis of herpes simplex virus (HSV) and varicella
zoster virus (VZV) infections is usually made clinically, the Tzanck test,
electron microscopy, viral culture, polymerase chain reaction (PCR), and
serologic tests can be utilized to verify the diagnosis. METHODS: We conducted a 
study on a total of 98 patients (77 patients with recurrent herpes simplex and 21
patients with herpes zoster) to evaluate the reliability and reproducibility of
the Tzanck test in comparison with PCR. RESULTS: In herpes virus infections, the 
general positivity rates of the Tzanck test and PCR were 61.2% and 79.6%,
respectively. The difference between the positivity rates of the two tests was
statistically significant. The positivity rates of the tests differed according
to the type and duration of the lesions. CONCLUSIONS: Although PCR was superior
to the Tzanck test, the Tzanck test has also been proven to be a reliable
diagnostic method, with a sensitivity of 76.9% and a specificity of 100%. We
recommend the use of this easy, quick, reproducible, and inexpensive diagnostic
test more often in dermatologic practice, especially in cutaneous herpes virus
infections.

Publication Types: 
    Comparative Study

PMID: 17988338 [PubMed - indexed for MEDLINE]

91: Int J Dermatol. 2007 Nov;46(11):1141-5.

Isotopic response of fungal granuloma following facial herpes zoster infections -
report of three cases.

Huang CW, Tu ME, Wu YH, Lin YC.

Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan.

BACKGROUND: An isotopic response is the occurrence of a new skin disease at the
site of another unrelated, healed skin disorder. METHODS: We report three cases
of unilateral granulomatous fungal infection in immunocompetent patients at sites
of resolved herpes zoster on the face. Diagnoses were made by potassium hydroxide
preparation, histopathologic findings, and fungal culture. Two patients had
Candida albicans folliculitis, and the other was infected with both
Epidermophyton floccosum and Trichophyton mentagrophytes. RESULTS: The patients
responded well to antifungal therapy. CONCLUSIONS: Localized isotopic fungal
infections, although rare, can occur in immunocompetent patients.

Publication Types: 
    Case Reports

PMID: 17988332 [PubMed - indexed for MEDLINE]

92: Afr J Reprod Health. 2007 Apr;11(1):133-6.

Maxillary herpes zoster with corneal involvement in a HIV positive pregnant
woman.

Omoti AE, Omoti CE.

Department of Opthalmology, University of Benin Teaching Hospital, Benin City.
Afeomoti@Yahoo.com

Corneal involvement in maxillary herpes zoster is very rare. This report presents
the case of a 32 years old 7 months pregnant para2+1 female, who presented with
vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the 
face on the left side with periocular oedema, conjunctivitis and mild punctate
keratitis in the left eye. She was HIV positive and was on treatment with the
highly active antiretroviral therapy. She was treated with topical and systemic
acyclovir with rapid resolution of the ocular features.

Publication Types: 
    Case Reports

PMID: 17982956 [PubMed - indexed for MEDLINE]

93: J Korean Med Sci. 2007 Oct;22(5):905-7.

A case of herpes zoster with abducens palsy.

Shin MK, Choi CP, Lee MH.

Department of Dermatology, College of Medicine, Kyunghee University, Seoul,
Korea.

Only a few reports have focused on ocular motor paralysis in herpes zoster
ophthalmicus. We report a case of ocular motor paralysis resulting from herpes
zoster. The patient, an 80-yr-old woman, presented with grouped vesicles,
papules, and crusting in the left temporal area and scalp, with diplopia,
impaired gaze, and severe pain. Her cerebrospinal fluid analysis was positive for
varicellar zoster virus IgM. Magnetic resonance imaging was performed to rule out
other diseases causing diplopia; there were no specific findings other than old
infarctions in the pons and basal ganglia. Therefore, she was diagnosed of
abducens nerve palsy caused by herpes zoster ophthalmicus. After 5 days of
systemic antiviral therapy, the skin lesions improved markedly, and the paralysis
was cleared 7 weeks later without extra treatment.

Publication Types: 
    Case Reports

PMID: 17982243 [PubMed - indexed for MEDLINE]

94: Vaccine. 2007 Nov 28;25(49):8326-37. Epub 2007 Oct 17.

Evaluation of the cost-effectiveness in the United States of a vaccine to prevent
herpes zoster and postherpetic neuralgia in older adults.

Pellissier JM, Brisson M, Levin MJ.

Merck Research Laboratories, Blue Bell, PA, United States.
james_pellissier@merck.com

CONTEXT: A live-attenuated varicella-zoster virus vaccine, demonstrated to reduce
the incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN) and the
morbidity associated with incident HZ and its sequelae, has recently been
approved for use in the United States (U.S.). OBJECTIVE: To examine the potential
value of zoster vaccine for society and payers. DESIGN, SETTING AND POPULATION:
An age-specific decision analytic model was designed to estimate the lifetime
costs and outcomes associated with HZ, PHN and other HZ-related complications for
vaccinated and non-vaccinated cohorts aged >or=60 years. Clinical trial data,
published literature and other primary studies were used to inform the model.
Robustness of results to key model parameters was explored through a series of
one-way, multivariate and probabilistic sensitivity analyses. Both societal and
payer perspectives were considered. MAIN OUTCOME MEASURE: Incremental cost per
quality-adjusted life year (QALY) gained. RESULTS: For a representative cohort of
1,000,000 U.S. vaccine recipients aged >or=60 years, use of the zoster vaccine
was projected to eliminate 75,548-88,928HZ cases and over 20,000 PHN cases. Over 
300,000 outpatient visits, 375,000 prescriptions, 9,700 ER visits and 10,000
hospitalizations were projected to be eliminated with the vaccine translating
into savings of US$ 82 million to US$ 103 million in healthcare costs associated 
with the diagnosis and treatment of HZ, PHN and other HZ-related complications.
Cost-effectiveness ratios range from US$ 16,229 to US$ 27,609 per QALY gained,
depending on the input data source and analytic perspective. Results were most
sensitive to PHN costs, duration of vaccine efficacy, vaccine efficacy against
PHN and HZ, QALY loss associated with pain states and complication costs.
CONCLUSIONS: The zoster vaccine at a price of US$ 150 is likely to be
cost-effective for a cohort of immunocompetent U.S. vaccine recipients aged
>or=60 years using commonly cited thresholds for judging cost-effectiveness.
Conclusions are robust over plausible ranges of input parameter values and a
broad range of scenarios and age cohorts.

PMID: 17980938 [PubMed - indexed for MEDLINE]

95: Waste Manag. 2007 Oct 31 [Epub ahead of print]

Measuring the gypsum content of C&D debris fines.

Musson SE, Xu Q, Townsend TG.

Department of Environmental Engineering Sciences, University of Florida,
Gainesville, FL 32611-6450, USA.

Construction and demolition (C&D) debris recycling facilities often produce a
screened material intended for use as alternative daily cover (ADC) at active
landfills or for shaping and grading at closed landfills. This product contains
soil and small pieces of wood, concrete, gypsum drywall, shingles and other
components of C&D debris. Concerns have been raised over the contribution of
gypsum drywall in C&D debris fines to odor problems at landfills where the
product is used. To address such concerns, limitations may be placed on the
percentage of gypsum (or sulfate) that can occur, and standardized testing
procedures are required to permit valid compliance testing. A test procedure was 
developed for measuring the gypsum content in C&D debris fines. The concentration
of sulfate leached in an aqueous solution was used to estimate the initial gypsum
content of the sample. The impact of sample size and leaching time were
evaluated. Precision and accuracy increased with increasing gypsum content.
Results from replicate samples had an average relative standard deviation of 9%. 
The gypsum content of fines obtained from different facilities in the US varied
widely from 1% to over 25%. These variations not only occurred between differing 
facilities, but within batches produced within a single facility.

PMID: 17980573 [PubMed - as supplied by publisher]

96: Mayo Clin Proc. 2007 Nov;82(11):1341-9.

Erratum in:
    Mayo Clin Proc. 2008 Feb;83(2):255.

A population-based study of the incidence and complication rates of herpes zoster
before zoster vaccine introduction.

Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS.

Department of Research, Olmsted Medical Center, 210 Ninth St SE, Rochester, MN,
USA. yawnx002@umn.edu

OBJECTIVE: To establish accurate, up-to-date, baseline epidemiological data for
herpes zoster (HZ) before the introduction of the recently licensed HZ vaccine.
METHODS: Using data from January 1, 1996, to October 15, 2005, we conducted a
population-based study of adult residents (Greater than or equal to 22 years) of 
Olmsted County, MN, to determine (by medical record review) the incidence of HZ
and the rate of HZ-related complications. Incidence rates were determined by age 
and sex and adjusted to the US population. RESULTS: A total of 1669 adult
residents with a confirmed diagnosis of HZ were identified between January 1,
1996, and December 31, 2001. Most (92%) of these patients were immunocompetent
and 60% were women. When adjusted to the US adult population, the incidence of HZ
was 3.6 per 1000 person-years (95% confidence interval, 3.4-3.7), with a temporal
increase from 3.2 to 4.1 per 1000 person-years from 1996 to 2001. The incidence
of HZ and the rate of HZ-associated complications increased with age, with 68% of
cases occurring in those aged 50 years and older. Postherpetic neuralgia occurred
in 18% of adult patients with HZ and in 33% of those aged 79 years and older.
Overall, 10% of all patients with HZ experienced 1 or more nonpain complications.
CONCLUSIONS: Our population-based data suggest that HZ primarily affects
immunocompetent adults older than 50 years; 1 in 4 experiences some type of
HZ-related complication.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17976353 [PubMed - indexed for MEDLINE]

97: Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2007 Sep;21(3):285-7.

[Zoster Chinese medicine treatment.]

[Article in Chinese]

Chen HM.

Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing
100050, China.

OBJECTIVE: Clinical diagnosis will clear any part of the human herpes zoster,
patients as soon as possible to alleviate the pain and suffering chinese soups
with oral treatment. METHODS: Will be advised by the People's Republic of China
Chinese medicine industry standards, TCM diagnosis of dermatological diseases
efficacy standards, Herpes Zoster State Administration of Traditional Chinese
Medicine 1994-06-28 approved, 1995-01-01 implementation Randomly divided into two
groups. Treatment and control groups, Treatment groups treated with Chinese
herbs. The control group were treated with WM. Since the proposed unification
formula, tell patients with customised soups boiling method. Add inguisitor first
slices, just cold water soaking, four hours after the use of force opened five,
slow fire just 10 minutes after each bowl, when oral temperature, twice good,
morning fasting drink, a throw into before falling asleep after serving
temperature. Treatment for a week, clinical observation. RESULTS: The group of
Chinese medicine is better than western medicine. CONCLUSION: Although Chinese
medicine in the diagnosis and treatment of the current lack of scientific and
quantitative criteria, but Chinese medicine in the treatment of skin diseases are
effectual, we will be in the modernization of Chinese medicine to do more
exploration. Key words: Herpes Zoster; Herpesviridee infection; Drugs, Chinese
herbal.

Publication Types: 
    English Abstract

PMID: 17971948 [PubMed - in process]

98: J Cataract Refract Surg. 2007 Nov;33(11):1855-9.

Laser in situ keratomileusis in patients with a history of ocular herpes.

de Rojas Silva V, Rodriguez-Conde R, Cobo-Soriano R, Beltran J, Llovet F, Baviera
J.

Clinica Baviera, Instituto Oftalmologico Europeo, Madrid, Spain.
vderojas@terra.es

PURPOSE: To report the outcomes of laser in situ keratomileusis (LASIK) in
patients with a history of ocular herpes simplex virus (HSV) or herpes zoster
ophthalmicus (HZO). SETTING: Clinica Baviera, Instituto Oftalmologico Europeo,
Madrid, Spain. METHODS: In this retrospective case series, the records of eyes
with a history of ocular herpes that had LASIK from 2003 through 2005 were
reviewed. The main outcome measure was postoperative recurrence of ocular herpes.
RESULTS: Forty-nine eyes (48 patients) with a history of ocular herpes (HSV
keratitis, 28 eyes; HSV eyelid lesions, 17 eyes; HZO, 4 eyes) were identified.
All LASIK procedures were uneventful. Herpetic disease was inactive at the time
of surgery in all eyes and for more than 1 year in 31 eyes. Perioperative
antiviral systemic prophylaxis was used in 13 patients with a history of HSV
keratitis. No eye developed reactivation of herpetic keratitis during the
follow-up (range 1 to 28 months). CONCLUSIONS: Laser in situ keratomileusis was
safe in patients with a history of ocular herpes; no recurrences occurred during 
the follow-up period. However, candidates should be selected with caution and
surgery performed only in eyes in which the herpes has been inactive for 1 year
before surgery, without stromal disease, and with regular topography and
pachymetry maps and normal corneal sensitivity. The most reasonable clinical
strategy is perioperative systemic antiviral prophylaxis.

PMID: 17964388 [PubMed - indexed for MEDLINE]

99: Pediatr Dermatol. 2007 Sep-Oct;24(5):557-8.

Zosteriform connective tissue nevus in a pediatric patient.

Brazzelli V, Muzio F, Barbagallo T, Fornara L, Donadini F, Guerci B, Mancini L,
Calcaterra V, Larizza D, Borroni G.

Department of Human and Hereditary Pathology, Institute of Dermatology,
University of Pavia, Fondazione, IRCCS Policlinico S. Matteo, Pavia, Italy.
vbrazzelli@libero.it <vbrazzelli@libero.it>

We report an 8-year-old girl affected by hypochromic, asymptomatic, acquired
lesions with a paving-stone aspect on the right lumbosacral area and proximal
right leg. The results of serum and urine biochemical screening were normal, as
was the bone survey A biopsy was performed. The clinical and histologic aspects
led to the diagnosis of connective tissue nevus with zosteriform distribution.

Publication Types: 
    Case Reports

PMID: 17958812 [PubMed - indexed for MEDLINE]

100: J Antimicrob Chemother. 2007 Dec;60(6):1316-30. Epub 2007 Oct 22.

Preclinical development of bicyclic nucleoside analogues as potent and selective 
inhibitors of varicella zoster virus.

McGuigan C, Pathirana RN, Migliore M, Adak R, Luoni G, Jones AT, Diez-Torrubia A,
Camarasa MJ, Velazquez S, Henson G, Verbeken E, Sienaert R, Naesens L, Snoeck R, 
Andrei G, Balzarini J.

Welsh School of Pharmacy, Cardiff University, King Edward VII Avenue, Cardiff
CF10 3XF, UK. mcguigan@cardiff.ac.uk

OBJECTIVES: To progress the anti-varicella-zoster-virus (VZV) aryl bicyclic
nucleoside analogues (BCNAs) to the point of Phase 1 clinical trial for herpes
zoster. METHODS: A new chromatography-free synthetic access to the lead anti-VZV 
aryl BCNAs is reported. The anti-VZV activity of lead Cf1743 was evaluated in
monolayer cell cultures and organotypic epithelial raft cultures of primary human
keratinocytes. Oral dosing in rodents and preliminary pharmacokinetics assessment
was made, followed by an exploration of alternative formulations and the
preparation of pro-drugs. We also studied uptake into cells of both parent drug
and pro-drug using fluorescent microscopy and biological assays. RESULTS: Cf1743 
proved to be significantly more potent than all reference anti-VZV compounds as
measured either by inhibition of infectious virus particles and/or by viral DNA
load. However, the very low water solubility of this compound gave poor oral
bioavailability (approximately 14%). A Captisol admixture and the
5'-monophosphate pro-drug of Cf1743 greatly boosted water solubility but did not 
significantly improve oral bioavailability. The most promising pro-drug to emerge
was the HCl salt of the 5'-valyl ester, designated as FV-100. Its uptake into
cells studied using fluorescent microscopy and biological assays indicated that
the compound is taken up by the cells after a short period of incubation and
limited exposure to drug in vivo may have beneficial effects. CONCLUSIONS: On the
basis of its favourable antiviral and pharmacokinetic properties, FV-100 is now
being pursued as the clinical BCNA candidate for the treatment of VZV shingles.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17956908 [PubMed - indexed for MEDLINE]

101: Clin Microbiol Infect. 2007 Dec;13(12):1217-9. Epub 2007 Oct 22.

High variability in viral load in cerebrospinal fluid from patients with herpes
simplex and varicella-zoster infections of the central nervous system.

Ruzek D, Piskunova N, Zampachova E.

Institute of Parasitology, Biology Centre of the Academy of Sciences of the Czech
Republic and Faculty of Biological Sciences, University of South Bohemia, Ceske
Budejovice, Czech Republic. ruzekd@paru.cas.cz

Infections of the central nervous system (CNS) caused by herpes viruses can
result in severe diseases, often with a fatal outcome. In this study, the viral
load in the cerebrospinal fluid (CSF) of patients with herpes simplex or
varicella-zoster infections of the CNS was measured using a quantitative
real-time PCR. The results suggest a high variability in viral load, with
relatively mild disease associated with a high viral load in CSF and vice versa. 
Determination of the viral load in CSF does not therefore seem to be useful in
assessing the prognosis of disease caused by these viruses.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17953699 [PubMed - indexed for MEDLINE]

102: Int J Infect Dis. 2007 Oct 17 [Epub ahead of print]

Incidence of herpes zoster and seroprevalence of varicella-zoster virus in young 
adults of South Korea.

Kang CI, Choi CM, Park TS, Lee DJ, Oh MD, Choe KW.

Department of Internal Medicine, Armed Forces Capital Hospital, San 13-4
Yul-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-040, Republic of Korea.

OBJECTIVES: This study was performed to determine the incidence of herpes zoster 
and seroprevalence of varicella-zoster virus (VZV) in young adults of South
Korea, where VZV seroprevalence remains relatively high. METHODS: In South Korea,
military service is compulsory for all healthy young men and hence those in
military service might provide a reflection of the general population. The
computerized database of the Armed Forces Medical Command was examined to
identify the number of reported herpes zoster cases. In order to evaluate VZV
seroprevalence, serum samples were obtained from randomly selected subjects among
those who had been admitted to the Armed Forces Capital Hospital. RESULTS: A
total of 705 cases of herpes zoster were reported between June 2004 and May 2005.
The annual incidence rate of herpes zoster was 141 (95% CI 131.0-151.8) per
100000 population. A total of 192 subjects were enrolled for the analysis of VZV 
seroprevalence. All subjects were male and their median age was 21 (range 19-24) 
years. The overall anti-VZV IgG seropositivity prevalence was 92.7% (178/192, 95%
CI 88.0-95.7%). CONCLUSION: We have described a population-based study of the
epidemiology of VZV infections in the military personnel of South Korea.

PMID: 17950022 [PubMed - as supplied by publisher]

103: J Fam Pract. 2007 Oct;56(10 Suppl A):51A-57A; quiz 58A.

Preventing herpes zoster and postherpetic neuralgia through vaccination.

High KP.

Section on Infectious Diseases, Department of Internal Medicine, Wake Forest
University School of Medicine, Winston-Salem, NC, USA.

Publication Types: 
    Review

PMID: 17949604 [PubMed - indexed for MEDLINE]

104: Lancet Neurol. 2007 Nov;6(11):1015-28.

The neurotropic herpes viruses: herpes simplex and varicella-zoster.

Steiner I, Kennedy PG, Pachner AR.

Neurological Sciences Unit, Hadassah University Hospital, Mount Scopus,
Jerusalem, Israel. isteiner@md2.huji.ac.il

Herpes simplex viruses types 1 and 2 (HSV1 and HSV2) and varicella-zoster virus
(VZV) establish latent infection in dorsal root ganglia for the entire life of
the host. From this reservoir they can reactivate to cause human morbidity and
mortality. Although the viruses vary in the clinical disorders they cause and in 
their molecular structure, they share several features that affect the course of 
infection of the human nervous system. HSV1 is the causative agent of
encephalitis, corneal blindness, and several disorders of the peripheral nervous 
system; HSV2 is responsible for meningoencephalitis in neonates and meningitis in
adults. Reactivation of VZV, the pathogen of varicella (chickenpox), is
associated with herpes zoster (shingles) and central nervous system complications
such as myelitis and focal vasculopathies. We review the biological, medical, and
neurological aspects of acute, latent, and reactivated infections with the
neurotropic herpes viruses.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17945155 [PubMed - indexed for MEDLINE]

105: Br J Haematol. 2007 Dec;139(5):791-8. Epub 2007 Oct 17.

Acquired immune-related and inflammatory conditions and subsequent chronic
lymphocytic leukaemia.

Landgren O, Gridley G, Check D, Caporaso NE, Morris Brown L.

Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics,
National Cancer Institute, NIH, Bethesda, MD, USA. landgreo@mail.nih.gov

Immune-mediated pathways have been recognized to be of importance in the
pathogenesis of chronic lymphocytic leukaemia (CLL). We assessed a broad variety 
of immune-related and inflammatory conditions and subsequent CLL development
among 4 million adult male veterans admitted to VA hospitals. We identified 3,680
CLL cases with up to 27 years of follow-up. Using Poisson regression analyses
restricted to immune-related or inflammatory conditions that occurred more than
one year before CLL, we estimated relative risk (RR) and 95% confidence intervals
for CLL risk. Elevated CLL risk was found among individuals with prior chronic
sinusitis (RR = 1.27, 1.01-1.61). Pneumonia had a borderline (RR = 1.13,
1.00-1.27) association with CLL; the risk was further elevated (RR = 1.35,
1.07-1.72) for latency <5 years. Conversely, chronic non-rheumatic valvular heart
disease was associated with 0.76-fold (0.58-0.99) decreased risk. Herpes zoster
and simplex were associated with increased (RR = 1.98, 1.40-2.79) and borderline 
increased (RR = 1.69, 0.96-2.98) CLL risk. There was no general association
between autoimmunity and CLL; however, autoimmune haemolytic anaemia was
associated with 3.86-fold (1.93-7.74) elevated CLL risk. Individuals with chronic
osteoarthritis and prostatitis had 1.14-fold (1.03-1.25) and 1.64-fold
(1.14-2.37) elevated CLL risk. These association patterns suggest primary focus
on infectious agents rather than autoantigens for future aetiologic CLL studies.

Publication Types: 
    Research Support, N.I.H., Intramural

PMID: 17941950 [PubMed - in process]

106: Herpes. 2007 Sep;14(2):45-7.

Case reports: zoster pain in haematological malignancies: effective pain relief
with oxycodone in patients unresponsive to other analgesic measures.

Niscola P, Perrotti AP, del Poeta G, Romani C, Palombi M, Piccioni D, Scaramucci 
L, Tolu B, Tendas A, Cupelli L, Abruzzese E, D'Elia GM, Brunetti GA, Maurillo L, 
Giovannini M, Cartoni C, de Fabritiis P.

Haematology Division, Sant'Eugenio Hospital, Tor Vergata University, Rome, Italy.
pasquale.niscola@uniroma2.it

Varicella zoster virus (VZV) outbreak is a significant cause of morbidity in
patients suffering from blood-related malignancies, occurring mostly among those 
affected by lymphoproliferative disorders and in those receiving haematopoietic
stem-cell transplantation. The elucidated pathological mechanisms of VZV-related 
painful complications have provided the rationale for acute zoster pain (AZP) and
post-herpetic neuralgia (PHN) treatment with antiviral therapy combined with
neuroactive agents, such as tricyclic or anticonvulsant agents. The role of
opioids in this setting is less clearly established. We successfully treated
(with oxycodone) 12 consecutive patients suffering from AZP and long-lasting PHN 
resistant to several agents, including anticonvulsants and analgesics. Our
experience is reported together with a brief overview of the management of these 
often distressing and intractable complications.

Publication Types: 
    Case Reports

PMID: 17939903 [PubMed - indexed for MEDLINE]

107: Herpes. 2007 Sep;14(2):32-6.

Managing herpes zoster in immunocompromised patients.

Ahmed AM, Brantley JS, Madkan V, Mendoza N, Tyring SK.

Baylor College of Medicine, Houston, TX, USA.

Herpes zoster infections are more common and often more complicated in
immunocompromised patients. The key clinical objective in these patients is to
reduce the incidence of cutaneous and visceral dissemination that can lead to
life-threatening complications. This is best achieved with prompt antiviral
therapy, which should be instituted in all immunosuppressed zoster patients if
presentation occurs within 1 week of rash onset or any time before full crusting 
of lesions. For localized disease, most patients can be treated with oral
valaciclovir, famciclovir or aciclovir, with close outpatient follow-up.
Intravenous aciclovir therapy is reserved for those with disseminated varicella
zoster virus infection, ophthalmic involvement, very severe immunosuppression or 
the inability to take oral medications. Foscarnet is the drug of choice to treat 
aciclovir-resistant herpes zoster. Appropriate analgesic therapy should be
combined with early antiviral treatment to reduce the incidence and severity of
acute zoster pain and post-herpetic neuralgia.

Publication Types: 
    Review

PMID: 17939900 [PubMed - indexed for MEDLINE]

108: Herpes. 2007 Sep;14(2):31.

Herpes zoster in immunocompromised patients.

Volpi A, Stanberry L.

Publication Types: 
    Editorial

PMID: 17939899 [PubMed - indexed for MEDLINE]

109: Rev Med Suisse. 2007 Sep 19;3(125):2116-22, 2124-9.

[Swiss recommendations for the management of varicella-zoster virus infections]

[Article in French]

Meylan P, Gerber S, Kempf W, Nadal D; Swiss Herpes Management Forum.

Institut de microbiologie et Division des maladies infectieuses, CHUV, Lausanne. 
pascal.meylan@chuv.ch

Infections with varicella zoster virus (VZV) are common viral infections
associated with significant morbidity. Diagnosis and management are complex,
particularly in immunocompromised patients and during pregnancy. The present
recommendations have been established by a multidisciplinary panel of specialists
and endorsed by numerous Swiss medical societies involved in the medical care of 
such patients (Appendix). The aim is to improve the care of affected patients and
to reduce complications.

Publication Types: 
    English Abstract
    Review

PMID: 17939531 [PubMed - indexed for MEDLINE]

110: Indian J Dermatol Venereol Leprol. 2007 Sep-Oct;73(5):352-3.

Persistent hiccups: a rare prodromal manifestation of herpes zoster.

Reddy BV, Sethi G, Aggarwal A.

Publication Types: 
    Case Reports
    Letter

PMID: 17921622 [PubMed - indexed for MEDLINE]

111: Lancet. 2007 Oct 6;370(9594):1240.

How shingles can be beached.

Ludwig RJ, Kaufmann R.

Department of Dermatology, Johann Wolfgang Goethe-Universitat, Frankfurt,
Germany. r.ludwig@em.uni-frankfurt.de

Publication Types: 
    Case Reports

PMID: 17920919 [PubMed - indexed for MEDLINE]

112: Vaccine. 2007 Nov 7;25(45):7866-72. Epub 2007 Aug 8.

The comparative sero-epidemiology of varicella zoster virus in 11 countries in
the European region.

Nardone A, de Ory F, Carton M, Cohen D, van Damme P, Davidkin I, Rota MC, de
Melker H, Mossong J, Slacikova M, Tischer A, Andrews N, Berbers G, Gabutti G, Gay
N, Jones L, Jokinen S, Kafatos G, de Aragon MV, Schneider F, Smetana Z, Vargova
B, Vranckx R, Miller E.

Health Protection Agency, Centre for Infections, London, UK.
a.nardone@invs.sante.fr

The European sero-epidemiology network (ESEN2) aims to standardise serological
surveillance of varicella zoster virus (VZV) in 11 participant countries. In each
country, serum banks were collected between 1996 and 2003 and tested for VZV
antibodies. Assay results were standardised so that international comparisons
could be made. Age-specific forces of infection were calculated for three age
groups (<5, 5-9 and >or=10 years of age) and used to estimate the base
reproduction number (R(0)) and the herd immunity threshold (H). Most VZV
infection occurred in childhood, but there was a wide variation in
transmissibility, with R(0) ranging from 16.9 in the Netherlands to 3.3 in Italy.
Herd immunity thresholds varied from 70% in Italy to 94% in the Netherlands.
There are substantial differences in VZV sero-epidemiology within the European
region, which will need to be taken into account in designing national policies
regarding VZV vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17919788 [PubMed - indexed for MEDLINE]

113: Actas Dermosifiliogr. 2007 Oct;98(8):576-8.

[Psoriasis at the site of healed herpes zoster: Wolf's isotopic response.]

[Article in Spanish]

Allegue F, Fachal C, Romo M, Lopez-Miragaya MI, Perez S.

Publication Types: 
    Letter

PMID: 17919439 [PubMed - indexed for MEDLINE]

114: J Virol. 2007 Dec;81(23):13200-8. Epub 2007 Oct 3.

A self-excisable infectious bacterial artificial chromosome clone of
varicella-zoster virus allows analysis of the essential tegument protein encoded 
by ORF9.

Tischer BK, Kaufer BB, Sommer M, Wussow F, Arvin AM, Osterrieder N.

Department of Microbiology and Immunology, College of Veterinary Medicine,
Cornell University, Ithaca, NY 14853, USA.

In order to facilitate the generation of mutant viruses of varicella-zoster virus
(VZV), the agent causing varicella (chicken pox) and herpes zoster (shingles), we
generated a full-length infectious bacterial artificial chromosome (BAC) clone of
the P-Oka strain. First, mini-F sequences were inserted into a preexisting VZV
cosmid, and the SuperCos replicon was removed. Subsequently, mini-F-containing
recombinant virus was generated from overlapping cosmid clones, and full-length
VZV DNA recovered from the recombinant virus was established in Escherichia coli 
as an infectious BAC. An inverted duplication of VZV genomic sequences within the
mini-F replicon resulted in markerless excision of vector sequences upon virus
reconstitution in eukaryotic cells. Using the novel tool, the role in VZV
replication of the major tegument protein encoded by ORF9 was investigated. A
markerless point mutation introduced in the start codon by two-step en passant
Red mutagenesis abrogated ORF9 expression and resulted in a dramatic growth
defect that was not observed in a revertant virus. The essential nature of ORF9
for VZV replication was ultimately confirmed by restoration of the growth of the 
ORF9-deficient mutant virus using trans-complementation via baculovirus-mediated 
gene transfer.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17913822 [PubMed - indexed for MEDLINE]

115: Pediatr Transplant. 2007 Nov;11(7):777-80.

Sirolimus in chronic allograft nephropathy in pediatric recipients.

Ibanez JP, Monteverde ML, Diaz MA, Goldberg J, Turconi AF.

Nephrology Unit, Hospital de Pediatria Prof Dr Juan P Garrahan Buenos Aires,
Argentina. juanibanez@sinectis.com.ar

CAN is a common cause of late graft loss. Nephrotoxicity due to CNIs is known to 
contribute to CAN. We retrospectively evaluated the efficacy and safety of SRL in
pediatric renal Tx recipients showing CAN in their allograft biopsy. Twenty-one
patients aged 10.4 +/- 4.6 yr at Tx time receiving CNIs as primary
immunosuppression were converted to SRL at 58.9 +/- 49.1 months after Tx, due to 
progressive decline of renal function and biopsy proven CAN. Mean follow-up after
switch was 19.7 +/- 9.5 months. All patients received CsA as part of the
immunosuppressive regimen, at a mean dose 4.4 +/- 1.2 mg/kg/day. Mean daily dose 
of SRL three month after conversion was 2.6 +/- 0.8 mg/body surface area/day and 
the mean through levels where 6.9 +/- 2.5 ng/mL. Graft biopsies showed Grade I
CAN in 12 children and Grade II CAN in nine. After SRL introduction, there were
neither acute rejection episodes nor graft losses. GFR improved at three months
and was sustained thereafter only in children with Grade I CAN. Post-Tx time at
conversion was the only significant variable between patients who had Grade I CAN
and Grade II CAN (33.6 +/- 33.3 vs. 92.7 +/- 47.5 months, p = 0.003). Nine
patients had no AEs, six patients had nine SAE: five diarrhea, one herpes zoster,
one pancreatic pseudo cyst, one pneumonia, and one Influenza A infection; 11
patients had 13 AEs: six oral aphthous ulcers, three urinary tract infections,
two herpes simplex, one lymphedema, and one nephrotic proteinuria. Significant
improvement of GFR occurred in Grade I CAN group at three months from conversion 
and was sustained during follow-up. Those who had Grade II CAN experienced no
change in GFR. The incidence of AEs and SAE is of concern and further studies are
necessary to assess their relevance.

PMID: 17910656 [PubMed - in process]

116: J Am Coll Surg. 2007 Oct;205(4):625. Epub 2007 Jul 20.

Metastatic colon adenocarcinoma mimicking herpes zoster.

Goodwin TL, Wren SM.

Stanford University School of Medicine, Stanford, CA, USA.

Publication Types: 
    Case Reports

PMID: 17903740 [PubMed - indexed for MEDLINE]

117: Med Sci Monit. 2007 Oct;13(10):CS128-31.

Varicella zoster-associated severe aplastic anemia in a child and its successful 
treatment with peripheral blood stem cell transplantation from HLA-5/6-identical 
donor.

Kuskonmaz B, Cetin M, Uckan D, Yetgin S.

Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University 
Faculty of Medicine, Sihhiye, Ankara, Turkey.

BACKGROUND: Varicella zoster virus is very rarely associated with aplastic
anemia. Bone marrow transplantation from an HLA-identical sibling is the
treatment of choice. CASE REPORT: A seven-year-old boy presented with aplastic
anemia (AA) following chicken pox infection. No clinical improvement was observed
with pharmaceutical therapy and peripheral blood stem cell transplantation
(PBSCT) was performed from his HLA 5/6 identical mother. Since the
transplantation, the patient has had a durable, trilineage hematological response
for 12 months. CONCLUSIONS: The present case with varicella zoster-associated
aplastic anemia was non-responsive to conventional therapies (ATG protocol, ALG
protocol, oxymethalone, and cyclosporine A) and successfully treated with bone
marrow transplantation from his 5/6 identical mother.

Publication Types: 
    Case Reports

PMID: 17901857 [PubMed - indexed for MEDLINE]

118: Anesth Analg. 2007 Oct;105(4):1127-9, table of contents.

A unique case of recurrent asystole secondary to paroxysmal pain of acute
herpetic ophthalmicus.

Cheung MY, Viney M.

Geelong Hospital, Victoria, Australia. manyiucheung@yahoo.com

Postherpetic neuralgia is considered to be the most common and debilitating
complication of acute herpes zoster and its incidence and duration of symptoms
increase with age. We describe an unusual, but life-threatening complication of
postherpetic neuralgia. The following case report is the first to describe a
patient who developed unexpected asystolic episodes as a result of complicating
pain secondary to acute herpetic ophthalmicus. The underlying pathogenesis of her
cardiovascular disturbance coinciding with her painful paroxysms is unclear. This
uncommon phenomenon may be explained by an exaggerated vasovagal response or even
by the oculocardiac reflex rarely observed outside ocular or maxillofacial
surgery. Her severe paroxysmal pain and asystole were eventually managed with
oxycontin, amitriptyline, gabapentin, and intranasal fentanyl spray.

Publication Types: 
    Case Reports

PMID: 17898398 [PubMed - indexed for MEDLINE]

119: J Virol. 2007 Dec;81(23):12758-65. Epub 2007 Sep 26.

Identification of five major and two minor genotypes of varicella-zoster virus
strains: a practical two-amplicon approach used to genotype clinical isolates in 
Australia and New Zealand.

Loparev VN, Rubtcova EN, Bostik V, Govil D, Birch CJ, Druce JD, Schmid DS,
Croxson MC.

Centers for Disease Control and Prevention, National Center for Preparedness,
Detection, and Control of Infectious Diseases, Atlanta, Georgia 30333, USA.

Whole genome phylogenetic analysis in this study resolved a total of five major
genotypes among the 22 varicella-zoster virus (VZV) strains or isolates for which
complete genomic sequences are available. Consistent with earlier publications we
have designated these genotypes European 1 (E1), European 2 (E2), Japanese (J),
mosaic 1 (M1), and mosaic 2 (M2). Single nucleotide polymorphism (SNP) analysis
performed in a whole-genome alignment revealed that VZV isolates of all five
genotypes can be accurately genotyped using SNPs from two amplicons: open reading
frame 22 (ORF22) and either ORF21 or ORF50. This modified approach identifies all
of the genotypes observed using any of the published genotyping protocols. Of 165
clinical varicella and zoster isolates from Australia and New Zealand typed using
this approach, 67 of 127 eastern Australian isolates were E1, 30 were E2, 16 were
J, 10 were M1, and 4 were M2; 25 of 38 New Zealand isolates were E1, 8 were E2,
and 5 were M1. VZV strain diversity in eastern Australia is thus broader than has
been described for any other region, including Europe, Africa, and North America.
J strains were far more prevalent than previously observed in countries other
than Japan. Two-amplicon typing was in complete accord with genotypes derived
using SNP in multiple ORFs (ORFs 1, 21, 22, 38, 50, 54, and 62). Two additional
minor genotypes, M3 and M4, could also be resolved using two-amplicon typing.

Publication Types: 
    Evaluation Studies

PMID: 17898056 [PubMed - indexed for MEDLINE]

120: Bull Soc Belge Ophtalmol. 2007;(303):23-6.

Herpes zoster ophthalmicus complicated by complete ophthalmoplegia and signs of
pilocarpine hypersensitivity. A case report and literature review.

Pion B, Salu P.

Dept. of Ophthalmology, Academic Hospital of the Free University of Brussels,
Laarbeeklaan 101, B-1090 Jette. bartpion@hotmail.com

We report a case of zona ophthalmica complicated with a complete ophthalmoplegia.
In the literature only 19 cases have been reported the last 30 years, with a
variety of possible pathophysiological mechanisms. Our patient's mydriasis
reacted to diluted pilocarpine 0.125% which is a sign of Adie's pupil and is not 
supposed to occur in mydriasis caused by a third nerve palsy. We review the
literature on the possible pathogenesis of this hypersensitivity.

Publication Types: 
    Case Reports
    Review

PMID: 17894283 [PubMed - indexed for MEDLINE]

121: Anesthesiology. 2007 Oct;107(4):678-9.

Cost effectiveness of epidural injection of steroids and local anesthetics for
relief of zoster-associated pain.

Opstelten W, van Wijck AJ, van Essen GA, Moons KG, Verheij TJ, Kalkman CJ, van
Hout BA.

Publication Types: 
    Letter

PMID: 17893478 [PubMed - indexed for MEDLINE]

122: Evid Based Dent. 2007;8(3):85-6.

Comment on:
    Cochrane Database Syst Rev. 2007;(2):CD004846.

Insufficient evidence to recommend topical lidocaine as first-line treatment for 
postherpetic neuralgia.

Zakrzewska JM.

Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital,
University College London NHS Foundation Trust, London, UK.

DATA SOURCES: The Cochrane Pain, Palliative and Supportive Care Group Trials
Register, Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS
(Latin American and Caribbean Health Sciences), SIGLE (System for Information on 
Grey Literature in Europe)(for conference proceedings) and Science Citation Index
were searched, along with the reference lists of all eligible trials, key
textbooks and previous systematic reviews. Authors of all identified trials were 
contacted. STUDY SELECTION: Studies of interest were randomised controlled trials
(RCT) or quasi-RCT comparing all topical applications of lidocaine, including
gels and patches in people of all ages suffering from postherpetic neuralgia
(PHN; pain persisting at the site of shingles at least 1 month after the onset of
the acute rash). DATA EXTRACTION AND SYNTHESIS: Data were extracted independently
by two authors with disputes resolved by a third reviewer. A meta-analysis was
conducted using a fixed-effect approach. RESULTS: Three trials were included,
giving a total of 182 individuals who used topical lidocaine and 132 controls.
Two trials provided data on pain relief, and the remaining study provided data on
secondary outcome measures. The largest trial published as an abstract compared a
topical lidocaine patch to a placebo patch and accounted for 150 of the 314
patients (48%). A meta-analysis combining two of the three studies identified a
significant difference between the topical lidocaine and control groups for the
primary outcome measure: a mean improvement in pain relief according to a pain
relief scale. Topical lidocaine relieved pain better than placebo (P 0.003).
There was a statistical difference between the groups for the secondary outcome
measure of mean score-reduction on a visual analogue scale (P 0.030), but this
was only for a single small trial. There were a similar number of adverse skin
reactions in both treatment and placebo groups. CONCLUSIONS: There is
insufficient evidence to recommend topical lidocaine as a first-line agent in the
treatment of PHN with allodynia. Further research should be undertaken on the
efficacy of topical lidocaine for other chronic neuropathic pain disorders, and
also to compare different classes of drugs (eg, topical anaesthetics versus
anti-epileptics).

Publication Types: 
    Comment

PMID: 17891129 [PubMed]

123: Vaccine. 2007 Oct 23;25(43):7598-604. Epub 2007 Aug 15.

Epidemiology and costs of herpes zoster: background data to estimate the impact
of vaccination.

Di Legami V, Gianino MM, Atti MC, Massari M, Migliardi A, Tomba GS, Zotti C;
Zoster Study Group.

Dipartimento di Sanita Pubblica e di Microbiologia, Universita degli Studi di
Torino, via Santena 5 bis, 10126 Torino, Italy. valeria.dilegami@unito.it

In 2004, we conducted a study in Piemonte (Italy), in order to describe
incidence, treatment, hospitalizations and costs of herpes zoster (HZ), in
population over 14 years of age. Twenty-four regional general practitioners, with
26,394 patients >14 years in charge (0.71% of the regional population), reported 
prospectively all diagnosed HZ cases. In addition, all regional hospital
discharge records were reviewed. Forty-six HZ cases treated at home were
reported, accounting for a total incidence of 1.74 cases/1000 population >14
years per year. HZ rate standardized by age on regional population 14 years older
is 1.59/1000. The cost per observed home case was 136.06 euros. The incidence of 
hospital admissions was 0.12/1000 inhabitants. The mean cost of hospitalized
cases was 4082.59 euros. These results contribute to depict the impact of HZ in
the general population, and to provide background data for setting-up either
mathematical models aimed to estimate the impact of vaccination on HZ, and the
cost-benefit analyses of various preventive and therapeutic scenarios.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17889410 [PubMed - indexed for MEDLINE]

124: Ophthal Plast Reconstr Surg. 2007 Sep-Oct;23(5):411-3.

Orbital myositis involving the oblique muscles associated with herpes zoster
ophthalmicus.

Badilla J, Dolman PJ.

Department of Ophthalmology, University of British Columbia, Vancouver, Canada.

An 81-year-old woman with right orbital inflammation and acute retinal necrosis
following Herpes zoster ophthalmicus was evaluated and treated. CT showed right
massive superior and inferior oblique enlargement and moderate enlargement of the
remaining extraocular muscles with tendon sparing. The myositis and acute retinal
necrosis dramatically improved following prednisone and intravenous acyclovir
therapy.

Publication Types: 
    Case Reports

PMID: 17881997 [PubMed - indexed for MEDLINE]

125: Curr Med Res Opin. 2007 Oct;23(10):2585-96.

Cost-effectiveness analysis of pregabalin versus gabapentin in the management of 
neuropathic pain due to diabetic polyneuropathy or post-herpetic neuralgia.

Rodriguez MJ, Diaz S, Vera-Llonch M, Dukes E, Rejas J.

Pain and Palliative Care Unit, Carlos Haya University Hospital, Malaga, Spain.
maje1946@yahoo.es

OBJECTIVE: To estimate the cost-effectiveness of branded pregabalin (PGB) versus 
generic gabapentin (GBP) in patients with neuropathic pain (NeP) due to painful
diabetic polyneuropathy (DPN) or post-herpetic neuralgia (PHN) in Spain. METHODS:
Using stochastic simulation, we estimated the cost-effectiveness of PGB 150-600
mg/d vs. GBP 900-3600 mg/d in a hypothetical cohort of 1000 patients. The model
used data from three randomized controlled clinical trials. Pain was evaluated
using a 0-10 scale. Mean baseline pain was 6.9 in both treatment groups. The
model assigned untreated pain scores over 84 days. Treated scores were calculated
using weekly changes in pain scores from trials. Outcomes included the numbers of
days with no or mild pain (score < 4), days with >or= 30% and >or= 50% reductions
in pain intensity, quality-adjusted life-years (QALYs), and estimated health
costs. RESULTS: Compared with GBP, PGB yielded an estimated mean of 8 (standard
error, 0.4) additional days with no or mild pain, 6 (0.4) days with >or= 30%
reduction in pain intensity, 9 (0.5) days with >or= 50% reduction in pain
intensity, and a gain of 0.1186 (0.0002) QALYs for 12 weeks. The estimated total 
health costs of therapies were euro 1049 (euro 35) for PGB and euro 951 (euro 38)
for GBP, respectively. Incremental cost-effectiveness ratio (ICER) for PGB versus
GBP were a mean of euro 12 (95% confidence interval, euro 1-24) per additional
day with no or mild pain, euro 431 (dominant-euro 876) per additional patient
with no or mild pain, and euro 20 535 (euro 1607-40 345) per QALY gained.
CONCLUSIONS: According with data used in this modeling in patients with NeP due
to DPN and/or PHN, PGB was shown to be more cost-effective than generic
gabapentin in Spain.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17875242 [PubMed - indexed for MEDLINE]

126: J Clin Microbiol. 2007 Dec;45(12):3909-14. Epub 2007 Sep 12.

Effect of viral load on the outcome of herpes zoster.

Quinlivan ML, Ayres K, Ran H, McElwaine S, Leedham-Green M, Scott FT, Johnson RW,
Breuer J.

Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts,
and the London School of Medicine and Dentistry, Queen Mary College, London, UK.

Varicella-zoster virus (VZV) is a member of the Herpesviridae family, primary
infection with which causes varicella, more commonly known as chicken pox.
Characteristic of members of the alphaherpesvirus subfamily, VZV is neurotropic
and establishes latency in sensory neurons. Reactivation of VZV causes herpes
zoster, also known as shingles. The most frequent complication following zoster
is chronic and often debilitating pain called postherpetic neuralgia (PHN), which
can last for months after the disappearance of a rash. During episodes of acute
zoster, VZV viremia occurs in some, but not all, patients; however, the effect of
the viral load on the disease outcome is not known. Here we describe the
development of a highly specific, sensitive, and reproducible real-time PCR assay
to investigate the factors that may contribute to the presence and levels of
baseline viremia in patients with zoster and to determine the relationship
between viremia and the development and persistence of PHN. VZV DNA was detected 
in the peripheral blood mononuclear cells (PBMCs) of 78% of patients with acute
zoster and in 9% of healthy asymptomatic blood donors. The presence of VZV in the
PBMCs of patients with acute zoster was independently associated with age and
being on antivirals but not with gender, immune status, extent of rash, the age
of the rash at the time of blood sampling, having a history of prodromal pain, or
the extent of acute pain. Prodromal pain was significantly associated with higher
baseline viral loads. Viral load levels were not associated with the development 
or persistence of PHN at 6, 12, or 26 weeks.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17855575 [PubMed - indexed for MEDLINE]

127: J Paediatr Child Health. 2007 Oct;43(10):713-5.

Herpes zoster due to Oka vaccine strain of varicella zoster virus in an
immunosuppressed child post cord blood transplant.

Chan Y, Smith D, Sadlon T, Scott JX, Goldwater PN.

Department of Infectious Diseases and Microbiology, Women's and Children's
Hospital, 72 King William Road, North Adelaide, SA 5006, Australia.

A 5-year-old boy was vaccinated with the Oka strain of varicella zoster virus
vaccine before cord blood transplant for chronic granulomatous disease in 2005.
In 2006, he developed herpes zoster on his left arm. DNA from the vesicular rash 
confirmed the Oka vaccine strain of varicella zoster virus caused this
complication. He responded well to 10 days of aciclovir treatment.

Publication Types: 
    Case Reports

PMID: 17854459 [PubMed - indexed for MEDLINE]

128: Eur Arch Otorhinolaryngol. 2008 Mar;265(3):365-7. Epub 2007 Sep 12.

Laryngeal zoster with multiple cranial nerve palsies.

Van Den Bossche P, Van Den Bossche K, Vanpoucke H.

Department of Internal Medicine, H.Hartziekenhuis Roeselare Menen vzw, Rijselse
straat, 71, 8930, Menen, Belgium, paul-vandenbossche@skynet.be.

A young immunocompetent patient is presented with a very rare presentation of a
common viral illness: herpes zoster of the left hemilarynx with sensorial and
motoric neuropathy of three ipsilateral lower cranial nerves: IX, X and XI. The
mucosal lesions were discovered during upper gastrointestinal endoscopy. PCR of
erosional exsudate confirmed the clinical diagnosis. Antiviral therapy and
corticosteroids possibly contributed to the prosperous evolution with complete
healing.

PMID: 17849136 [PubMed - in process]

129: Neurologist. 2007 Sep;13(5):313-7.

Segmental zoster paresis of limbs: report of three cases and review of
literature.

Kawajiri S, Tani M, Noda K, Fujishima K, Hattori N, Okuma Y.

Department of Neurology, Juntendo University Shizuoka Hospital, Shizuoka, Japan.

OBJECTIVES: Segmental zoster paresis is a relatively rare complication
characterized by focal motor weakness, which may occur in limbs affected by
herpes zoster. We demonstrate the clinical characteristics of segmental zoster
paresis by reviewing the cases of 138 patients, including 3 of our patients. CASE
REPORT AND REVIEW SUMMARY: We report 3 patients with zoster paresis of the limbs.
Patients 1 and 3 showed motor weakness in the left shoulder and arm after
developing a herpetic rash in the left C5-C6 dermatomes. Patient 2 showed
weakness in the right thigh and groin after a right L2-L3 herpetic eruption. The 
electromyograms of all 3 patients showed abnormal spontaneous activity in the
affected muscles. Intravenous acyclovir and corticosteroid pulse therapy were
added to oral antiviral drugs for patients 1 and 2. All 3 patients recovered
favorably. Our review of the literature revealed that antiviral treatment may
prevent the occurrence of zoster paresis; however, there is insufficient evidence
to show what treatment hastens recovery from zoster paresis. CONCLUSIONS:
Segmental zoster paresis is still underrecognized by neurologists. Awareness of
this disorder is important because it may eliminate unnecessary invasive
investigations and lead to appropriate treatment. Further studies on the
treatment are necessary.

Publication Types: 
    Case Reports

PMID: 17848871 [PubMed - indexed for MEDLINE]

130: Herpes. 2007 Jun;14(1):4-10.

Herpetic retinitis.

Cordero-Coma M, Anzaar F, Yilmaz T, Foster CS.

Massachusetts Eye Research and Surgery Institute, Cambridge, MA 02142, USA.

This paper provides an appreciation of the various forms and consequences of
retinal inflammation caused by human herpesviruses. Herpes simplex virus types 1 
and 2, varicella zoster virus, cytomegalovirus and Epstein-Barr virus are known
to cause retinitis. The prognosis of herpetic retinitis remains poor because it
is associated with a high incidence of complications, both during and after the
acute disease phase. On diagnosis of retinal necrosis, antiviral treatment must
be started promptly to limit disease progression; following this, prophylactic
maintenance therapy may be required.

Publication Types: 
    Review

PMID: 17848212 [PubMed - indexed for MEDLINE]

131: J Am Med Dir Assoc. 2007 Sep;8(7):419-20.

How should nursing homes use vaccine to prevent zoster?

Drinka PJ.

Publication Types: 
    Editorial

PMID: 17845943 [PubMed - indexed for MEDLINE]

132: Intern Med. 2007;46(17):1487-8. Epub 2007 Sep 3.

Constipation and segmental abdominal paresis followed by herpes zoster.

Maeda K, Furukawa K, Sanada M, Kawai H, Yasuda H.

Division of Neurology, Department of Medicine, Shiga University of Medical
Science. kengo@belle.shiga-med.ac.jp

Publication Types: 
    Case Reports

PMID: 17827858 [PubMed - indexed for MEDLINE]

133: Clin Ther. 2007 Jul;29(7):1491-507.

Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for
postherpetic neuralgia in the United Kingdom.

Dakin H, Nuijten M, Liedgens H, Nautrup BP.

Abacus International, Bicester, Oxfordshire, United Kingdom.
helen.dakin@abacusint.com

BACKGROUND: Approximately 50% of elderly patients develop postherpetic neuralgia 
(PHN) after herpes zoster infection (shingles). A lidocaine 5% medicated plaster 
marketed in the United Kingdom in January 2007 has been shown to be an effective 
topical treatment for PHN with minimal risk of systemic adverse effects.
OBJECTIVE: This paper assessed the cost-effectiveness of using a lidocaine
plaster in place of gabapentin in English primary care practice to treat those
PHN patients who had insufficient pain relief with standard analgesics and could 
not tolerate or had contraindications to tricyclic antidepressants (TCAs). The
analysis took the perspective of the National Health Service (NHS). METHODS: The 
costs and benefits of gabapentin and the lidocaine plaster were calculated over a
6-month time horizon using a Markov model. The model structure allowed for
differences in costs, utilities, and transition probabilities between the initial
30-day run-in period and maintenance therapy and also accounted for add-in
medications and drugs received by patients who discontinued therapy. Most
transition probabilities were based on non-head-to-head clinical trials
identified through a systematic review. Data on resource utilization,
discontinuation rates, and add-in or switch medications were obtained from a
Delphi panel; cost data were from official price tariffs. Published utilities
were adjusted for age and were supplemented and validated by the Delphi panel.
RESULTS: Six months of therapy with the lidocaine plaster cost pound 549 per
patient, compared with pound 718 for gabapentin, and generated 0.05 more
quality-adjusted life-years (QALYs). The lidocaine plaster therefore dominated
gabapentin (95% CI, dominant- pound 2163/QALY gained). Probabilistic sensitivity 
analysis showed that there was a 90.15% chance that the lidocaine plaster was
both less costly and more effective than gabapentin and a 99.99% chance that it
cost < pound 20,000/QALY relative to gabapentin. Extensive deterministic
sensitivity analyses confirmed the robustness of the conclusions. CONCLUSION:
This study found that the lidocaine 5% medicated plaster was a cost-effective
alternative to gabapentin for PHN patients who were intolerant to TCAs and in
whom analgesics were ineffective, from the perspective of the NHS.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17825701 [PubMed - indexed for MEDLINE]

134: J Indian Med Assoc. 2007 Apr;105(4):216-7.

Human immunodeficiency virus infection in a child presenting as herpes zoster
ophthalmicus.

Pandey N, Chandrakar AK, Adile SL, Garg ML, Patel S.

Department of Ophthalmology, Pt JNM Medical College, Raipur 492009.

Herpes zoster is mainly a disease of the elderly. Its occurrence in younger age
should be viewed with suspicion. A 9-year-old boy presented with herpes zoster
ophthalmicus. He had a history of abdominal surgery one and half years back
during which he had received blood transfusion. A year following the surgery he
developed general malaise and fever with progressive weight loss. He was treated 
by local doctors. Subsequently he developed eruptions of blisters around right
eye for a duration of 8 days, with which he presented to the department of
ophthalmology, Pt JNM Medical College, Raipur. On investigations he was found to 
have infected with human immunodeficiency virus. Systemic acyclovir along with
antiretroviral treatment was started, to which he showed favourable response.

Publication Types: 
    Case Reports

PMID: 17822193 [PubMed - indexed for MEDLINE]

135: Pediatr Rev. 2007 Sep;28(9):343-51.

Index of suspicion.

Rapson A, Rappaport DI, Holman L, Michaud L, Doyne E, Durrani A, Lanuza K, Ang J,
Kamat D, Silver ES.

Jefferson Medical College, Philadelphia, PA, USA.

Publication Types: 
    Case Reports

PMID: 17766593 [PubMed - indexed for MEDLINE]

136: Vaccine. 2007 Oct 10;25(41):7087-93. Epub 2007 Aug 15.

Phenotypic and functional characterization of ex vivo T cell responses to the
live attenuated herpes zoster vaccine.

Patterson-Bartlett J, Levin MJ, Lang N, Schodel FP, Vessey R, Weinberg A.

Department of Pediatrics of the University of Colorado School of Medicine,
Denver, CO 80262, USA.

To define the phenotypic characteristics and kinetics of T cell responses to a
shingles vaccine in elderly individuals, 20 subjects > or =60 years of age
received two doses of vaccine or placebo 6 weeks apart. VZV-specific T cell
phenotypes and intracellular cytokines were determined by flow cytometry on blood
mononuclear cells obtained pre-vaccination and up to 6 months after the second
immunization. Results were compared with responses of five unvaccinated young
adults. Pre-vaccination, elderly individuals had significantly lower VZV-specific
effectors and cytokine-producing T cells compared with young adults. The vaccine 
significantly increased VZV-specific Th1, memory, early effector, and cutaneous
homing receptor-bearing T cells.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 17766015 [PubMed - indexed for MEDLINE]

137: J Infect Dis. 2007 Oct 1;196(7):1014-20. Epub 2007 Aug 29.

Varicella-zoster-virus genotypes in East London: a prospective study in patients 
with herpes zoster.

Sengupta N, Taha Y, Scott FT, Leedham-Green ME, Quinlivan M, Breuer J.

Department of Virology, Centre for Infectious Diseases, Institute of Cell
Molecular Sciences, Queen Mary School of Medicine and Dentistry, Barts,
Whitechapel, London, E1 2AT, United Kingdom. n.sengupta@qmul.ac.uk

A total of 298 patients with herpes zoster were recruited as part of 2
community-based studies in East London between 1998 and 2003. Single
nucleotide-polymorphism analysis of 4 regions (genes 1, 21, 37, and 60) found
that most genotypes were European strains C and B, representing 58% and 21% of
all samples collected. No change in the proportion of these European clades has
occurred during the past 80 years, strongly supporting the hypothesis that these 
strains are indigenous to the United Kingdom. White patients almost exclusively
had reactivation of genotypes C (66%) and B (21%), whereas patients from Africa, 
Asia, or the Caribbean mainly had reactivation of genotypes A and J. An increase 
in BglI-positive A and J genotypes in UK cases of zoster is only partly explained
by immigration from endemic regions. The data presented provide a baseline
against which to evaluate changes in the molecular epidemiology of
varicella-zoster virus and the effect of immunization with the Japanese Oka
vaccine strain.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17763323 [PubMed - indexed for MEDLINE]

138: J Clin Virol. 2007 Oct;40(2):129-34. Epub 2007 Aug 28.

Detection and differentiation of wild-type and vaccine mutant varicella-zoster
viruses using an Invader Plus method.

Tang YW, Allawi HT, DeLeon-Carnes M, Li H, Day SP, Schmid DS.

Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
37232, USA. yiwei.tang@vanderbilt.edu

We report the use of a prototype Invader Plus method (Third Wave Technologies,
Inc., Madison, WI) for the qualitative detection of varicella-zoster virus (VZV) 
and differentiation of wild-type and Oka vaccine VZV. The analytical sensitivity 
of the VZV Invader Plus reagents is at 10 copies per reaction. A total of 174
skin and mucous swab specimens were used to validate the assay's performance. The
sensitivity and specificity were 98.3% and 98.1%, respectively, in comparison to 
a PCR-EIA assay. A perfect 100% agreement was obtained when VZV wild-type and
vaccine differentiation was performed on 54 VZV-positive swab specimens against
an allele-specific FRET real-time assay. The Invader Plus method provides another
reliable tool for qualitative detection of VZV and differentiation of wild-type
and vaccine virus.

PMID: 17728179 [PubMed - indexed for MEDLINE]

139: Zhongguo Zhen Jiu. 2007 Jul;27(7):536-40.

[Systematic assessment of acupuncture for treatment of herpes zoster in domestic 
clinical studies]

[Article in Chinese]

Yu XM, Zhu GM, Chen YL, Fang M, Chen YN.

Acupuncture Department, Yueyang Hospital of Integrated TCM and Western Medicine
Affiliated to Shanghai University of TCM, China.

OBJECTIVE: To assess the effectiveness of acupuncture for treatment of herpes
zoster. METHODS: According to the requirement of evidence-based medicine,
acupuncture, body acupuncture, electroacupuncture, head acupuncture, three edged 
needle, plum-blossom needle, fire needle, elongated needle, encircling needling, 
herpes zoster, etc. were selected as subject words to retrieve the relative
medical database at home, and clinically randomized controlled trials were used
as enrolled criteria, the treatment group were treated with acupuncture or
acupuncture plus other therapies, and the control group with medicine, the cured 
rate and the time of killing pain for herpes zoster were used as assessment
indexes. Altogether 43 papers were enrolled. Among them 10 papers were conducted 
for Meta-analysis by RevMan 4.2.9. RESULTS: The total OR was 4.27 with 95% CI
[2.90, 6.29] of the clinically cured rate in the 10 studies, and the total OR was
-7.64 with 95% CI [-8.12, -7.15] of the time of killing pain in the 4 studies.
The therapeutic effect in the treatment group on herpes zoster was superior to
that of the western medicine (P < 0.01). CONCLUSION: Acupuncture therapy for
herpes zoster is effective, but more high-quality studies are required to prove
this view point.

Publication Types: 
    English Abstract
    Meta-Analysis

PMID: 17722838 [PubMed - indexed for MEDLINE]

140: J Infect Chemother. 2007 Aug;13(4):270-2. Epub 2007 Aug 27.

Varicella zoster virus meningoencephalitis accompanied by sporadic skin lesions
in an older immunocompetent adult.

Sugisaki K, Yoshida H.

Department of Internal Medicine, Jusendo General Hospital, 1-8-16 Ekimae,
Koriyama, Fukushima 963-8585, Japan. kota_sugisaki@ryumachi-jp.com

A previously healthy 75-year-old man complained of persistent fever, headache,
nausea, mild gait disturbance, memory disorder, and sporadic vesicular skin
lesions. Viral meningoencephalitis was diagnosed, based on cerebrospinal fluid
(CSF) analysis. Intensive CSF analysis suggested that the patient's illness was
caused by varicella zoster virus (VZV). The patient recovered completely after
treatment with intravenous acyclovir. VZV infection should be considered as a
possible cause of central nervous system disease, even in an immunocompetent
patient. VZV reactivation was strongly suspected because of the results of
anti-VZV antibody evaluations in serum and CSF, although the skin lesions were
not similar to those of herpes zoster.

Publication Types: 
    Case Reports

PMID: 17721692 [PubMed - indexed for MEDLINE]

141: Nurse Pract. 2007 Sep;32(9):19-24, quiz, 24-5.

Herpes zoster: prevention, diagnosis, and treatment.

Wilson DD.

Mennonite College of Nursing, Illinois State University, Normal, IL, USA.

Publication Types: 
    Review

PMID: 17721355 [PubMed - indexed for MEDLINE]

142: Harv Health Lett. 2007 Aug;32(10):1-2.

The shingles vaccine. Why hasn't it caught on? The cost and other factors are to 
blame.

[No authors listed]

PMID: 17717891 [PubMed - indexed for MEDLINE]

143: Epidemiol Infect. 2007 Aug;135(6):883-6.

Vaccination to prevent zoster in the elderly.

Gershon AA.

Publication Types: 
    Editorial

PMID: 17717853 [PubMed - indexed for MEDLINE]

144: J Eur Acad Dermatol Venereol. 2007 Sep;21(8):1112-4.

Postzoster cutaneous pseudolymphoma in a patient with B-cell chronic lymphocytic 
leukaemia.

Moreira E, Lisboa C, Azevedo F, Principe F, Lima M.

Publication Types: 
    Case Reports
    Letter

PMID: 17714139 [PubMed - indexed for MEDLINE]

145: Consult Pharm. 2007 Jul;22(7):593-8.

Postherpetic neuralgia in an elderly patient.

Cappuzzo KA, Krogsund RR.

Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
23298-0533, USA. kacappuzzo@vcu.edu

A 67-year-old patient presented to the community pharmacy with poorly controlled 
postherpetic neuralgia (PHN) pain following an episode of herpes zoster. The
clinical pharmacist did a medication review and found that, although the patient 
was receiving medications proven effective in the treatment of PHN, she was not
receiving optimal therapy. Additionally, the patient was experiencing intolerable
side effects. The pharmacist provided recommendations to the patient's primary
care physician that ultimately improved the patient's pain control. Managing PHN 
pain requires practitioners to be vigilant in titrating pain regimens and trying 
various combinations of therapies with different mechanisms of action. Such an
approach is one that tailors medication therapy to each individual patient,
provides the most relief, and restores a patient's quality of life.

Publication Types: 
    Case Reports

PMID: 17714004 [PubMed - indexed for MEDLINE]

146: Mymensingh Med J. 2007 Jul;16(2):221-4.

Herpes zoster ophthalmicus in an otherwise healthy 7 years child.

Akhanda AH, Quayum MA, Uddin A, Ahmed N, Uddin T, Ahmed T.

Department of Ophthalmology, Mymensingh Medical College, Mymensingh, Bangladesh.

A 07 years otherwise healthy child, non vaccinated for chickenpox and with a
history of chickenpox infection at 02 years of age presented with red colored
lesions in right upper lid, right side of forehead, vertex and right side of nose
and defective vision in right eye in Mymensingh Medical College Hospital, 20 days
after the appearance of blister in the same region. On examination granulation
tissue was present on the same area. There was no hair and skin over that area.
Lesion was strictly limited to right side of midline. Eyelashes of right upper
lid were absent and there was defective closure of eyelids. Best corrected visual
acuity of right eye was 3/60 and of left eye was 6/6. There was ciliary
congestion of right eye with haziness of cornea at interpalpebral region of right
eye. Corneal sensitivity was reduced and there was uniform fluorescein staining
at central part of cornea. Mild flare and cells were present in anterior chamber.
Fundus examination revealed no abnormality. He was treated with systemic
acyclovir, antibiotics, topical acyclovir, antibiotic and atropine. Corneal ulcer
and skin lesions were healed, but the patient developed cicatricial ectropion of 
right upper lid and best corrected visual acuity of right eye was reduced to 6/60
due to corneal opacity. So early diagnosis and treatment of herpes zoster
ophthalmicus is mandatory to prevent sight threatening complications.

Publication Types: 
    Case Reports

PMID: 17703164 [PubMed - indexed for MEDLINE]

147: JAAPA. 2007 Jul;20(7):56.

Patient information. Should I get the shingles vaccine?

[No authors listed]

PMID: 17695100 [PubMed - indexed for MEDLINE]

148: JAAPA. 2007 Jul;20(7):55.

Should I get the shingles vaccine?

Iverson K.

Emergency Treatment Center, University of Iowa Hospitals and Clinics, Iowa City, 
USA.

PMID: 17695099 [PubMed - indexed for MEDLINE]

149: J Assoc Physicians India. 2007 Apr;55:308-9.

Ramsay Hunt syndrome presenting as cranial polyneuropathy.

Padhiary KN, Mishra A, Routray P.

Publication Types: 
    Case Reports
    Letter

PMID: 17695066 [PubMed - indexed for MEDLINE]

150: Transpl Infect Dis. 2007 Sep;9(3):237-40.

Unusual presentation of central nervous system manifestations of Varicella zoster
virus vasculopathy in renal transplant recipients.

Hovens MM, Vaessen N, Sijpkens YW, de Fijter JW.

Department of General Internal Medicine, Leiden University Medical Centre,
Leiden, The Netherlands. m.m.c.hovens@lumc.nl

We describe 2 renal transplant recipients with severe but reversible neurological
manifestations related to Varicella zoster virus (VZV) cerebral vasculopathy. To 
the best of our knowledge, this is the first description of cerebral VZV
vasculopathy in solid organ transplant recipients. We review the published
literature on the clinical presentation, diagnosis and treatment. In solid organ 
transplant recipients presenting with neurological signs and symptoms, a
diagnosis of VZV-associated vasculopathy should be considered.

Publication Types: 
    Case Reports

PMID: 17692072 [PubMed - indexed for MEDLINE]

151: Harv Mens Health Watch. 2007 Jul;11(12):8.

On call. Your article on new immunizations for adults was very helpful. I already
got my booster for tetanus, diphtheria, and whooping cough, but even though I'm
61, my doctor didn't want to give me the shingles because I've already had
shingles. Should I get the vaccine?

Simon HB.

PMID: 17687797 [PubMed - indexed for MEDLINE]

152: Acta Otorrinolaringol Esp. 2007 Aug-Sep;58(7):311-5.

[Viral infection of herpes simplex, Epstein-Barr, varicela zoster, human
papilloma, cytomegalovirus, or adenovirus are not related to sinonasal
adenocarcinomas]

[Article in Spanish]

Perez Escuredo J, Llorente JL, Melon S, de Ona M, Garcia Martinez J, Alvarez
Marcos C, Hermsen M.

Departamento de Otorrinolaringologia, IUOPA, Hospital Universitario Central de
Asturias, Oviedo, Asturias, Espana.

OBJECTIVE: Several types of virus have been implicated in the development of head
and neck tumors. However, until now sinonasal adenocarcinomas (ACN) have not been
studied. The aim of this study is to screen a series of ACN for the presence of a
number of viruses known to play a role in cancer. MATERIAL AND METHOD: Viral DNA 
sequences of herpes simplex virus, Epstein-Barr, varicela zoster, human
papilloma, cytomegalovirus, and adenovirus were analysed by PCR in 37 primary
ACN. RESULTS: Three tumors (8.1%) were positive for Epstein-Barr virus and 1 case
(2.7%) for cytomegalovirus. CONCLUSIONS: Viral infections do not seem to play a
role in the etiology of ACN.

Publication Types: 
    English Abstract
    Research Support, Non-U.S. Gov't

PMID: 17683698 [PubMed - indexed for MEDLINE]

153: Cleve Clin J Med. 2007 Jul;74(7):489-94, 496, 498-9 passim.

Comment in:
    Cleve Clin J Med. 2007 Jul;74(7):472.

The protean neurologic manifestations of varicella-zoster virus infection.

Nagel MA, Gilden DH.

Department of Neurology, University of Colorado Health Sciences Center, Denver
80262, USA.

Multiple neurologic complications may follow the reactivation of varicella-zoster
virus (VZV), including herpes zoster (also known as zoster or shingles),
postherpetic neuralgia, vasculopathy, myelitis, necrotizing retinitis, and zoster
sine herpete (pain without rash). These conditions can be difficult to recognize,
especially as several can occur without rash.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17682626 [PubMed - indexed for MEDLINE]

154: Cleve Clin J Med. 2007 Jul;74(7):472.

Comment on:
    Cleve Clin J Med. 2007 Jul;74(7):489-94, 496, 498-9 passim.

Zoster is more than 'just' a viral infection.

Mandell BF.

Publication Types: 
    Comment
    Editorial

PMID: 17682624 [PubMed - indexed for MEDLINE]

155: Lakartidningen. 2007 Jun 13-26;104(24-25):1916-20.

[Risk of CNS adverse effects of aciclovir and valaciclovir. Watch the renal
function in treatment of herpes simplex and herpes zoster]

[Article in Swedish]

Hellden A, Bergman U, Dwyer R, Medin C, Molanaei H, Stahle L, Thylen P,
Odar-Cederlof I.

Institutionen for laboratoriemedicin, Karolinska institutet.
anders.hellden@karolinska.se

Publication Types: 
    Case Reports

PMID: 17674672 [PubMed - indexed for MEDLINE]

156: Eur J Ophthalmol. 2007 Jul-Aug;17(4):683-4.

Herpetic optic neuritis associated with herpetic keratitis.

Saenz-Frances F, Calvo-Gonzalez C, Jimenez-Santos M, Mendez-Hernandez C,
Fernandez-Vidal AM, Martinez-de-la-Casa JM, Garcia-Sanchez J, Garcia-Feijoo J.

Department of Ophthalmology, Hospital Clinico Universitario San
Carlos-Universidad Complutense, 28003 Madrid, Spain.
federicosaenzfrancessb@gmail.com

PURPOSE: To report a case of herpetic optic neuritis associated with herpetic
keratitis. METHODS: A 65 year old woman presented with oedema in the nasal sector
of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation 
rate and C-reactive protein were all normal. The patient was diagnosed as having 
a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp
examination showed diffuse stromal corneal oedema and a dendritic lesion in the
nasal zone of the corneal epithelium. RESULTS: Serology for varicela-zoster virus
was positive. Treatment was started with valacyclovir given orally and topical
acyclovir ointment. A week later, the optic disc swelling and corneal lesions had
resolved. CONCLUSIONS: The precise mechanism through which the papilla and cornea
were successively affected in our patient is unclear but the sensitive
innervation of both these structures is provided by the nasal branch of the
nasociliary nerve and the spread of herpes via this nerve could affect both
sites.

Publication Types: 
    Case Reports

PMID: 17671953 [PubMed - indexed for MEDLINE]

157: J Dermatolog Treat. 2007;18(4):255.

Herpes zoster, bacterial superinfections and antibiotics.

Veraldi S, Schianchi R.

Publication Types: 
    Letter

PMID: 17671888 [PubMed - indexed for MEDLINE]

158: Actas Dermosifiliogr. 2007 Sep;98(7):494-6.

[Zosteriform cutaneous leiomyoma. Satisfactory treatment with oral doxazosin]

[Article in Spanish]

Chaves AJ, Fernandez-Recio JM, de Argila D, Rodriguez-Nevado I, Catalina M.

Unidad de Dermatologia, Hospital Universitario Infanta Cristina, Badajoz, Espana.
antoniojchaves@yahoo.es

We report a 50-year-old man that presented a zosteriform cutaneous leiomyoma in
the left facial region, intensely painful, that showed great improvement after
the administration of a daily dose of 4 mg of oral doxasozin. The therapy was
well tolerated and did not present any associated adverse effect. In the English 
medical literature only two cases successfully treated with doxasozin have been
reported.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17669306 [PubMed - indexed for MEDLINE]

159: Ann Fam Med. 2007 Jul-Aug;5(4):305-9.

Clinical diagnosis of herpes zoster in family practice.

Opstelten W, van Loon AM, Schuller M, van Wijck AJ, van Essen GA, Moons KG,
Verheij TJ.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, The Netherlands. w.opstelten@umcutrecht.nl

PURPOSE: Family physicians usually diagnose herpes zoster on clinical grounds
only, possibly resulting in false-positive diagnoses and unnecessary treatment.
We wanted to determine the positive predictive value of the physicians' judgment 
in diagnosing herpes zoster and to assess the applicability of dried blood spot
analysis for diagnosis of herpes zoster in family practice. METHODS: Our study
population consisted of 272 patients older than 50 years with herpes zoster (rash
for less than 7 days). Dried blood spot samples were collected from all patients 
and sent by mail to the laboratory. Baseline measurements included clinical signs
(localization, severity, and duration of rash) and symptoms (duration and
severity of pain). Varicella-zoster virus antibodies were determined at baseline 
and 5 to 10 days later. Multivariate logistic regression was used to assess
independent associations between clinical variables and serological confirmation 
of herpes zoster. RESULTS: Dried blood spot analysis was possible in 260 patients
(96%). In 236 the diagnosis of herpes zoster was confirmed serologically
(positive predictive value of clinical judgment 90.8%; 95% confidence interval,
87.3%-94.3%). Independent clinical variables for serologically confirmed herpes
zoster were severity and duration of rash at first examination. CONCLUSION:
Family physicians have good clinical judgment when diagnosing herpes zoster in
older patients. Dried blood spot analysis is a logistically convenient method for
serological investigation of patients in family practice, but it is rarely needed
for diagnosing herpes zoster.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17664496 [PubMed - indexed for MEDLINE]

160: J Neurol Sci. 2007 Nov 15;262(1-2):113-6. Epub 2007 Jul 30.

On the viral hypothesis of multiple sclerosis: participation of varicella-zoster 
virus.

Sotelo J.

Neuroimmunology Unit, National Institute of Neurology and Neurosurgery, Mexico
City, Mexico. jsotelo@servidor.unam.mx

Recent studies, including our own, have accumulated evidence suggesting the
etiological participation of varicella-zoster virus in multiple sclerosis. If
confirmed, complex issues of individual susceptibility and immunopathogenesis
would have to be unveiled.

Publication Types: 
    Review

PMID: 17663004 [PubMed - indexed for MEDLINE]

161: Arch Pediatr. 2007 Sep;14(9):1092-3. Epub 2007 Jul 26.

[Infantile herpes zoster]

[Article in French]

Atmani S, Elouardi M, Bouharrou A, Hida M.

Departement de pediatrie, hopital universitaire de Fes, faculte de medecine et de
pharmacie de Fes, route Sidi-Hrazem, km 2,200, BP 1893, 30000 Fes, Maroc.
samir.atmani8@caramail.com

Herpes zoster occurs seldom in infants, especially in the absence of exposure to 
maternal varicella either intrauterine or postnatal. We report on a case in a
3-month-old infant admitted for herpes zoster in the sciatic nerve territory. No 
cutaneous eruption was found in the mother or in people who were in contact with 
the patient. This rare clinical situation is here reviewed, showing that the
absence of antenatal or postnatal exposure to herpes viruses does not preclude
the occurrence of herpes zoster infection in early infancy.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17662580 [PubMed - indexed for MEDLINE]

162: J Am Geriatr Soc. 2007 Aug;55(8):1168-75.

Healthcare costs of acute and chronic pain associated with a diagnosis of herpes 
zoster.

Dworkin RH, White R, O'Connor AB, Baser O, Hawkins K.

Department of Anesthesiology, School of Medicine and Dentistry, University of
Rochester, Rochester, New York 14642, USA. robert_dworkin@urmc.rochester.edu

OBJECTIVES: To determine the healthcare costs of acute and chronic pain
associated with herpes zoster. DESIGN: Retrospective cohort analysis. SETTING:
Inpatient and outpatient care. PARTICIPANTS: Patients were selected from
Medicare, commercial insurance, and Medicaid claims databases if they had a
diagnosis of herpes zoster or postherpetic neuralgia (PHN) or were prescribed
analgesics after a diagnosis of herpes zoster (possible PHN) and were matched to 
controls for demographic and clinical factors using propensity scores.
MEASUREMENTS: One-year excess healthcare expenditures attributable to herpes
zoster pain or PHN were calculated for inpatient, outpatient, and prescription
drug services. RESULTS: For the Medicare cohort, the average excess cost per
patient was $1,300 in the year after a diagnosis of herpes zoster with 30 days or
fewer of analgesic use and ranged from $2,200 to $2,300 per patient with PHN or
possible PHN. Patients with possible PHN were 53% more prevalent than patients
with PHN in the Medicare cohort and accounted for half of all excess
expenditures. Findings were similar in the younger cohorts with commercial
insurance and Medicaid except that costs attributable to PHN and possible PHN
were higher, and patients with possible PHN were three to five times as prevalent
as patients with PHN. CONCLUSION: Healthcare costs associated with PHN were
substantially greater than those associated with herpes zoster pain that resolved
within 30 days. The data suggest that as many as 80% of patients with PHN may not
be diagnosed with PHN and that these patients account for at least half of PHN
expenditures.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17661954 [PubMed - indexed for MEDLINE]

163: Invest Ophthalmol Vis Sci. 2007 Aug;48(8):3689-97.

Identification of viral antigens recognized by ocular infiltrating T cells from
patients with varicella zoster virus-induced uveitis.

Milikan JC, Kinchington PR, Baarsma GS, Kuijpers RW, Osterhaus AD, Verjans GM.

Institute of Virology, Erasmus Medical Center, Rotterdam.

PURPOSE: Varicella zoster virus (VZV) is a common cause of infectious uveitis
associated with an intraocular inflammatory response involving virus-specific T
cells. In the current study, the functional characteristics and the antigen
specificity of VZV-reactive T cells recovered from intraocular fluid (IOF)
samples of five patients with VZV were determined. METHODS: B-cell lines were
infected with a comprehensive panel of recombinant vaccinia viruses expressing 11
individual VZV open reading frames (ORFs), or alternatively pulsed with the
corresponding peptides to generate antigen-presenting cells (APCs). T-cell
responsiveness of the IOF-derived VZV-specific T cells toward APCs was monitored 
by interferon (IFN)-gamma enzyme-linked immunosorbent spot-forming assays on bulk
T-cell cultures and subsequently T-cell clones (TCCs). The cytokine-secretion
profile and cytotoxicity of the VZV-specific TCCs was determined by ELISA and
flow cytometry, respectively. RESULTS: T-cell reactivity to VZV proteins encoded 
by ORF4, -10, -14, -18, -29, -31, -61, -62, -63, -67, and -68 was demonstrated,
but specificity varied individually. T-cell epitopes on ORF62 and -68 were
delineated. The TCCs secreted IFNgamma, but relatively low levels of
interleukin-4 and -5, in response to VZV antigen-expressing APCs. The TCCs
induced antigen-specific cytotoxic T-cell activity. CONCLUSIONS: The results
suggest that the intraocular VZV-specific T-cell response in the patients with
VZV analyzed is directed to a broad spectrum of VZV antigens, including the
latency-associated VZV proteins from ORFs 4, 29, 63, and particularly ORF62. This
local T-cell response was in part mediated by cytotoxic CD4(+) T cells with a
Th1/0-like effector memory phenotype.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17652740 [PubMed - indexed for MEDLINE]

164: Int J Dermatol. 2007 Aug;46(8):883-4.

Acyclovir-induced neuropsychosis successfully recovered after immediate
hemodialysis in an end-stage renal disease patient.

Yang HH, Hsiao YP, Shih HC, Yang JH.

Department of Dermatology, Chung Shan Medical University Hospital, Taichung,
Taiwan 402.

A 70-year-old man developed herpes zoster over the right L5-S2 region for 3 days 
and was admitted for acyclovir therapy. He had a medical history of rectal cancer
status post-colostomy and end-stage renal disease undergoing thrice weekly
hemodialysis. Without a prior loading dose, acyclovir 500 mg (7.7 mg/kg) daily
was given intravenously in two divided doses. On the third dosage, the patient
became confused and agitated and developed insomnia. Within the following 24 h,
delirium, visual and auditory hallucinations, disorientation to place and time,
as well as impaired recent memory occurred. At the same time, a transient low
grade fever (38 degrees C) was noted but resolved spontaneously after ice pillow 
(Fig. 1). The etiology was vigorously explored. He had no history of any
neurological or psychiatric disorders. Drug history was reviewed, but no other
medications besides acyclovir were currently being used. Physical examination
revealed neither meningeal signs nor focal neurological deficits. Serum blood
urea nitrogen, glucose, and electrolytes were within normal limits except for an 
elevated creatinine level at 6.2 and 5.7 mg/dl (before and after neuropsychotic
symptoms, respectively). Complete blood count with differentiation was also
unremarkable. Cerebrospinal fluid examination was not possible as the patient's
family refused the lumbar puncture. Moreover, an electroencephalograph study and 
head computed tomography scan disclosed no abnormalities. Acyclovir-induced
neurotoxicity was suspected. Therefore, acyclovir was discontinued. Subsequently,
serum acyclovir and CMMG were checked by enzyme-linked immunosorbent assay. Serum
acyclovir level was 1.6 mg/l (normal therapeutic level, 0.12-10.8 mg/l) and CMMG 
level was 5 mg/l. Emergent hemodialysis (4-h/session) was given; the
neuropsychotic symptoms, including agitation, delirium, and visual and auditory
hallucinations, greatly abated after the second session. The patient fully
recovered after three consecutive days of hemodialysis; the serum was rechecked
and revealed that the acyclovir level was below 0.5 mg/l and the CMMG level was
undetectable. At the same time, his herpetic skin lesions resolved well.

Publication Types: 
    Case Reports

PMID: 17651180 [PubMed - indexed for MEDLINE]

165: Neurology. 2007 Jul 24;69(4):398-400.

VZV spinal cord infarction identified by diffusion-weighted MRI (DWI).

Orme HT, Smith AG, Nagel MA, Bert RJ, Mickelson TS, Gilden DH.

Department of Neurology, University of Utah School of Medicine, Salt Lake City,
UT, USA.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural

PMID: 17646633 [PubMed - indexed for MEDLINE]

166: Am J Clin Dermatol. 2007;8(4):221-33.

Dermatologic adverse effects of antiretroviral therapy: recognition and
management.

Luther J, Glesby MJ.

Upstate Medical School, State University of New York, Syracuse, New York, USA.

Despite the decrease in opportunistic infections associated with HIV in the
highly active antiretroviral treatment (HAART) era, a significant number of
patients still present with skin pathology, some of which can be attributed
directly or indirectly to antiretroviral therapy. The non-nucleoside reverse
transcriptase inhibitors exhibit a class effect with regard to skin adverse
manifestations, and the spectrum of disease can vary from a mild morbilliform
rash to Stevens-Johnson syndrome. Certain protease inhibitors are associated with
rash, and indinavir causes retinoid-like manifestations such as paronychia,
alopecia, ingrown toe-nails, and curling of straight hair. Abacavir, a nucleoside
reverse transcriptase inhibitor, is notorious for causing a hypersensitivity
reaction in select patients. The fusion inhibitor enfuvirtide causes
injection-site reactions in the overwhelming majority of patients, although a new
method of delivery has decreased the rate and severity of these reactions. A
syndrome of lipoatrophy with or without lipohypertrophy, often termed
lipodystrophy, has been described in patients receiving HAART. Potential
management of lipoatrophy includes switching antiretrovirals and surgical
treatment with facial fillers. Lastly, skin manifestations of the immune
reconstitution inflammatory syndrome, including herpes zoster and warts, must be 
recognized and treated accordingly. In the evaluation of the individual
HIV-infected patient receiving antiretroviral therapy who presents with a skin
disorder, clinicians should consider the CD4 cell count as a marker of the degree
of immunodeficiency, the specific antiretrovirals used, and the timing of the
initiation of antiretroviral therapy in order to formulate a rational
differential diagnosis. Management should be individualized based on the specific
drug that is implicated and the severity of the reaction.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17645377 [PubMed - indexed for MEDLINE]

167: Oncology. 2006;71(3-4):164-7. Epub 2007 Jul 18.

Herpes infections in breast cancer patients treated with adjuvant chemotherapy.

Masci G, Magagnoli M, Gullo G, Morenghi E, Garassino I, Simonelli M, Santoro A.

Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Milan,
Italy. giovanna.masci@humanitas.it

OBJECTIVE: There is little information on Herpes zoster infection in breast
cancer patients as a complication during adjuvant chemotherapy. The aim of this
study is to evaluate the incidence of Herpes zoster and simplex infections in
this patients setting. METHODS: We analyzed 623 early-stage breast cancer
patients in our Institute over a period of 7 years (1998-2005). Four-hundred and 
sixty-one patients were treated with anthracycline-based chemotherapy, 116 with
CMF and 46 with taxane-containing regimens. RESULTS: Twelve (1.9%) developed
herpes zoster; 9 patients, receiving anthracycline-based chemotherapy, two
taxane-containing regimens, and one CMF regimen. Herpes zoster infection required
treatment delay in 6 patients. Adjuvant chemotherapy was delayed for 1 week in 2 
patients, while in 4 patients with more severe symptoms chemotherapy was delayed 
for 2 weeks. One patient, despite i.v. acyclovir, had severe postherpetic motor
neuropathy with a permanent ambulation impairment, and chemotherapy was stopped. 
In our study, herpes zoster occurred in 55/1,000 cases/year. The reported
incidence in the general population varies between 2.2 and 4.1 per 1,000
patients/year; therefore, the risk of developing herpes zoster in these patients 
may be 13- to 25-fold higher compared to the incidence in the general population.
In addition, 13 of 623 patients developed herpes simplex. CONCLUSION: Our
findings suggest that adjuvant chemotherapy can facilitate reactivation of herpes
infection.

PMID: 17641534 [PubMed - indexed for MEDLINE]

168: J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):818.

Neurological picture. Herpes zoster duplex bilateralis.

Peretz A, Nowatzky J, Steiner I.

Department of Internal Medicine, Hadassah University Hospital Mount Scopus,
Jerusalem 91240, Israel. asafp@bgu.ac.il

Publication Types: 
    Case Reports

PMID: 17635977 [PubMed - indexed for MEDLINE]

169: Clin Geriatr Med. 2007 Aug;23(3):615-32, vii-viii.

Herpes zoster and postherpetic neuralgia in older adults.

Schmader K.

Center for the Study of Aging and Human Development and Division of Geriatrics,
Department of Medicine, Duke University Medical Center, Box 3469, Durham, NC
27710, USA. schma001@mc.duke.edu

Herpes zoster (HZ) afflicts millions of older adults annually and causes
significant suffering from acute and chronic pain, or postherpetic neuralgia
(PHN). HZ is caused by the reactivation of varicella-zoster virus (VZV) in
sensory ganglia in the setting of age, disease, and drug-related decline in
cellular immunity. VZV-induced neuronal destruction and inflammation cause the
pain, interference with activities of daily living, and reduced quality of life. 
The optimal treatment of HZ requires early antiviral therapy and pain management.
For PHN, evidence-based pharmacotherapy can reduce pain burden. The zoster
vaccine is effective in reducing pain burden and preventing HZ and PHN in older
adults.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Review

PMID: 17631237 [PubMed - indexed for MEDLINE]

170: Med Arh. 2007;61(2):128-30.

[Retrobulbar optic neuritis as first sign of HIV infection]

[Article in Bosnian]

Alimanovic-Halilovic E, Ibisevic M.

Klinika za ocne bolesti, KCU Sarajevo. ilda@bih.net.ba

This case is about a unilateral retrobulbar optic neuritis, as rare and first
sing of HIV infection. A young woman had came at Eye Clinic because suddenly she 
lost her sight on the right eye completely. At the visual field, we found
anopsia, but at the stereoscopic fundus examination the situation was almost
normal. After complete clinical examination we conclude that she is
immunodeficiency person, HIV-positive, with clinical manifestation retrobulbar
neuritis and with skin manifestation varicella zoster infection in region of the 
left arm.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17629153 [PubMed - indexed for MEDLINE]

171: RN. 2007 Jun;70(6):27-31; quiz 32.

Shingles: what you should know.

Novatnack E, Schweon S.

St. Luke's Hospital, Bethlehem, PA, USA.

Publication Types: 
    Review

PMID: 17624059 [PubMed - indexed for MEDLINE]

172: J Ethnobiol Ethnomed. 2007 Jul 10;3:29.

Use of traditional medicines in the management of HIV/AIDS opportunistic
infections in Tanzania: a case in the Bukoba rural district.

Kisangau DP, Lyaruu HV, Hosea KM, Joseph CC.

Department of Botany, University of Dar es Salaam, Dar es Salaam, Tanzania.
kisangau@yahoo.com

BACKGROUND: Ethnobotanical surveys were carried out to document herbal remedies
used in the management of HIV/AIDS opportunistic infections in Bukoba Rural
district, Tanzania. The district is currently an epicenter of HIV/AIDS and
although over 90% of the population in the district relies on traditional
medicines to manage the disease, this knowledge is impressionistic and not well
documented. The HIV/AIDS opportunistic conditions considered during the study
were Tuberculosis (TB), Herpes zoster (Shingles), Herpes simplex (Genital
herpes), Oral candidiasis and Cryptococcal meningitis. Other symptomatic but
undefined conditions considered were skin rashes and chronic diarrhea. METHODS:
An open-ended semi-structured questionnaire was used in collecting field
information. Descriptive statistics were used to analyze the ethnobotanical data 
collected. Factor of informant consensus (Fic) was used to analyze the
ethnobotanical importance of the plants. RESULTS: In the present study, 75 plant 
species belonging to 66 genera and 41 families were found to be used to treat one
or more HIV/AIDS related infections in the district. The study revealed that TB
and oral candidiasis were the most common manifestations of HIV/AIDS
opportunistic infections affecting most of the population in the area. It unveils
the first detailed account of ethnomedical documentation of plants focusing the
management of HIV/AIDS related infections in the district. CONCLUSION: It is
concluded that the ethnopharmacological information reported forms a basis for
further research to identify and isolate bioactive constituents that can be
developed to drugs for the management of the HIV/AIDS opportunistic infections.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 17623081 [PubMed - indexed for MEDLINE]

173: MMW Fortschr Med. 2006 Oct 26;148(43):41-3.

[Stepped analgesic approach to herpes zoster pain]

[Article in German]

Ludwig J, Baron R.

Klinik fur Neurologie, Universitatsklinikum Schleswig-Holstein, Kiel.

PMID: 17619424 [PubMed - indexed for MEDLINE]

174: N Engl J Med. 2007 Jul 5;357(1):89-90.

Comment on:
    N Engl J Med. 2007 Mar 29;356(13):1338-43.

Varicella-zoster vaccine.

Senanayake SN.

Publication Types: 
    Comment
    Letter

PMID: 17615639 [PubMed - indexed for MEDLINE]

175: N Engl J Med. 2007 Jul 5;357(1):89.

Comment on:
    N Engl J Med. 2007 Mar 29;356(13):1338-43.

Varicella-zoster vaccine.

Lang PO, Herrmann F, Michel JP.

Publication Types: 
    Comment
    Letter

PMID: 17615638 [PubMed - indexed for MEDLINE]

176: N Engl J Med. 2007 Jul 5;357(1):89.

Comment on:
    N Engl J Med. 2005 Jun 2;352(22):2271-84.    N Engl J Med. 2007 Mar 29;356(13):1338-43.

Varicella-zoster vaccine.

Good CB.

Publication Types: 
    Comment
    Letter

PMID: 17615637 [PubMed - indexed for MEDLINE]

177: N Engl J Med. 2007 Jul 5;357(1):89.

Comment on:
    N Engl J Med. 2007 Mar 29;356(13):1338-43.

Varicella-zoster vaccine.

Keller DL.

Publication Types: 
    Comment
    Letter

PMID: 17615636 [PubMed - indexed for MEDLINE]

178: Ocul Immunol Inflamm. 2007 May-Jun;15(3):241-8.

Evidence for antigen-specific immune deviation in patients with acute retinal
necrosis. 2001.

Kezuka T, Sakai JI, Usui N, Streilein JW, Usui M.

Publication Types: 
    Biography
    Classical Article
    Historical Article

Personal Name as Subject: 
    Kezuka T
    Sakai JI
    Usui N
    Streilein JW

PMID: 17613838 [PubMed - indexed for MEDLINE]

179: Cancer Invest. 2007 Jun;25(4):249-55.

Selective lymphopenia and opportunistic infections in neuroendocrine tumor
patients receiving temozolomide.

Schwarzberg AB, Stover EH, Sengupta T, Michelini A, Vincitore M, Baden LR, Kulke 
MH.

Harvard Medical School, Boston, Massachusetts, USA. aschwarzberg@partners.org

Temozolomide is utilized as a treatment for a variety of solid tumors and has
been associated with the development of selective lymphopenia. We evaluated the
incidence of lymphopenia and opportunistic infections during treatment and up to 
12 months following treatment discontinuation in a cohort of 39 patients
receiving temozolomide for advanced neuroendocrine tumors. The incidence of Grade
3-4 lymphopenia was 46 percent after 4 months of therapy and remained at 30
percent or greater for 12 months following treatment discontinuation. The overall
incidence of opportunistic infections was 10 percent, while among patients
receiving therapy for > or =7 months, the incidence was 20 percent. Prophylaxis
for Pneumocystis jiroveci pneumonia and varicella-zoster, as well as
cytomegalovirus monitoring, should be considered in patients receiving
temozolomide-based treatment.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17612935 [PubMed - indexed for MEDLINE]

180: MMW Fortschr Med. 2007 Mar 1;149(9):10-2.

[Properly managing leg pain]

[Article in German]

Wepner U.

Publication Types: 
    Case Reports
    News

PMID: 17612241 [PubMed - indexed for MEDLINE]

181: Eur Arch Otorhinolaryngol. 2007 Dec;264(12):1491-5. Epub 2007 Jul 5.

Significance of electromyography to predict and evaluate facial function outcome 
after acute peripheral facial palsy.

Grosheva M, Guntinas-Lichius O.

Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 
Cologne, Germany.

The prognostic value of electromyography (EMG) and its significance to estimate
facial function outcome after acute facial palsy is still unclear. We
retrospectively analysed the EMG reports of 494 patients with acute facial palsy 
treated from 1995 to 2005 in a tertiary referral centre. Initial and final facial
functions were assessed by the House-Brackmann (HB) scale. Serial EMG results
were classified into neurapraxia, axonotmesis/neurotmesis, mixed lesion, complete
recovery, defective healing, or not classifiable. Initial HB was II-IV in 321
patients and V-VI in 173 cases. The aetiology was idiopathic palsy in 294,
iatrogenic lesion in 86, traumatic in 52, Herpes zoster in 37, and of various
origin in 25 patients. EMG revealed neurapraxia in 300 patients,
axonotmesis/neurotmesis in 95 patients, and mixed lesion in 23 cases. EMG was not
meaningful in 76 patients. The follow-up time ranged from 0.3-264 months. Final
EMG revealed a full recovery in 160 patients, whereas 219 patients showed signs
of defective healing. In 155 patients, EMG was not significant to classify the
final outcome. The predictive EMG value for poor outcome was 77-86% and for
recovery 53%. The mean EMG recovery time was 2.3 months. Mean time for defective 
healing was 4.3 months. Final HB was normal (HB I) in 323 patients, HB II-IV in
115 patients, and V-VI in 46 patients. We conclude that EMG has a high predictive
value for unfavourable outcome after acute facial palsy. EMG is more sensible to 
detect signs of defective healing than clinical evaluation of facial function.

PMID: 17611766 [PubMed - in process]

182: N Engl J Med. 2007 Jul 5;357(1):88.

Comment on:
    N Engl J Med. 2007 Mar 29;356(13):1338-43.

Varicella-zoster vaccine.

Woo EJ, Ball R, Braun MM.

Publication Types: 
    Comment
    Letter

PMID: 17611214 [PubMed - indexed for MEDLINE]

183: J Fam Pract. 2007 Jul;56(7):551-3.

A young girl with blisters on her forehead.

Sarabi K, Selim A, Khachemoune A.

Loma Linda University Medical School, Loma Linda, CA, USA.

Publication Types: 
    Case Reports

PMID: 17605947 [PubMed - indexed for MEDLINE]

184: J Clin Virol. 2007 Aug;39(4):322-5. Epub 2007 Jun 28.

Ramsay Hunt syndrome complicated by a brainstem lesion.

Kim JH, Chung PW, Oh S, Hong SB, Chung CS, Jung CW, Kim ST, Hong SD, Seo DW.

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School
of Medicine, 50 Ilwon-dong, Gangnam-Gu, Seoul 135-710, Republic of Korea.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 17604687 [PubMed - indexed for MEDLINE]

185: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Oct;104(4):455-60.
Epub 2007 Jun 29.

Herpes zoster infection as an immune reconstitution inflammatory syndrome in
HIV-seropositive subjects: a review.

Feller L, Wood NH, Lemmer J.

Department of Periodontology and Oral Medicine, School of Dentistry, Faculty of
Health Sciences, University of Limpopo, Medunsa Campus, South Africa.
lfeller@medunsa.ac.za

The use of highly active antiretroviral therapy (HAART) in the management of
human immunodeficiency virus (HIV) infection has resulted paradoxically in the
worsening of clinical symptoms of previously subclinical infections, such as
herpes zoster (HZ), herpes simplex, angular cheilitis, warts, tuberculosis,
hepatitis B and C, cytomegalovirus retinitis, and others, as a result of
substantial reconstitution of the host's immune responses. This phenomenon is
referred to as immune reconstitution inflammatory syndrome (IRIS). It may affect 
up to 32% of HIV-seropositive subjects within a wide range of time after the
initiation of HAART, but mainly after 8-12 weeks. Mucocutaneous HZ accounts for
7%-12% of the diseases associated with HIV infection that become worse again when
the subject's immunity improves from the administration of HAART. It usually
occurs after 4 weeks from the initiation of HAART, and under these circumstances 
the clinical symptoms and natural course of mucocutaneous HZ are similar to those
in HIV-seropositive subjects who do not manifest IRIS.

Publication Types: 
    Review

PMID: 17604657 [PubMed - indexed for MEDLINE]

186: Nursing. 2007 Jul;37(7):29.

Myths and facts...about shingles.

Quillen TF.

PMID: 17603352 [PubMed - indexed for MEDLINE]

187: Urol J. 2005 Fall;2(4):193-6.

Frequency of infectious skin lesions in kidney transplant recipients.

Alimagham M, Amini-Afshar S, Farahmand S, Pour-Kazemi A, Pour-Reza-Gholi F,
Masood S.

Department of Infectious Diseases, Shaheed Labbafinejad Medical Center, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran.
dr.mahnazaalimagham@yahoo.com.

INTRODUCTION: This study was performed to evaluate the frequency of skin lesions 
in kidney transplant recipients. MATERIALS AND METHODS: A total of 681 kidney
transplant recipients were followed at Shaheed Labbafinejad transplant center in 
Tehran, Iran. Skin lesions were evaluated, and diagnoses were made clinically and
confirmed by lesion smear, tissue biopsy, tissue culture, and serologic
examinations, as indicated. RESULTS: Skin lesions were found in 54 patients
(7.9%), and their frequencies were as follows: dermatomal herpes zoster (18
patients, 2.6%, 13 men and 5 women), herpes simplex infection of face and lips
(15 patients, 2.2%, 5 men and 10 women), chickenpox (6 patients, 0.9%, 5 men and 
1 woman), Kaposi's sarcoma (5 patients, 0.7%, 3 men and 2 women), warts (4 women,
2 of whom had genital warts), pyoderma gangrenosum (1 man, 0.14%), multiple
fungal abscesses of the leg (1 man, 0.14%), mucormycosis (1 man, 0.14%), and
molluscum contagiosum (1 man, 0.14%). Moreover, 2 women (0.3%) had generalized
herpes simplex lesions. CONCLUSION: Frequencies of herpes zoster (3.5%), herpes
simplex (2.5%), and human papillomavirus (0.6%) infections in our kidney
transplant recipients were low. We recommend that all kidney transplant
candidates be evaluated and immunized for herpes zoster virus before
transplantation, all herpetic-form lesions of these patients be reported to
physicians (even mild lesions), and finally, that all human papillomavirus
lesions be diagnosed and treated promptly to prevent more serious lesions such as
malignancies.

PMID: 17602428 [PubMed - in process]

188: Pharmacotherapy. 2007 Jul;27(7):1013-9.

Zoster vaccine live.

Kockler DR, McCarthy MW.

Drug Information Services, Virginia Commonwealth University Health System-Medical
College of Virginia Hospitals, and the Virginia Commonwealth University School of
Pharmacy, Charlottesville, Virginia 23298-0042, USA. dkockler@mcvh-vcu.edu

Herpes zoster is a neurocutaneous disease caused by the varicella-zoster virus
and is associated with significant morbidity and long-term sequelae in older
adults. Until recently, treatment options for these complications have been
primarily targeted at disease state management and symptom relief. Zoster vaccine
live is the first vaccine approved for the prevention of herpes zoster. The
vaccine was approved by the United States Food and Drug Administration for adults
aged 60 years or older. Results of the Shingles Prevention Study demonstrated
that in older individuals, administration of zoster vaccine live reduces the
burden of illness associated with herpes zoster by 61.1%, the frequency of herpes
zoster pain and discomfort by 51.3%, and the frequency of postherpetic neuralgia 
by 66.5%. Overall, adverse events reported in clinical trials of zoster vaccine
live were classified as mild. Events that occurred more frequently in zoster
vaccine live recipients than in placebo recipients included injection site
reactions, headache, respiratory infections, fever, flu syndrome, diarrhea,
rhinitis, skin disorders, respiratory disorders, and asthenia. The Centers for
Disease Control and Prevention's Advisory Committee on Immunization Practices
recently recommended universal vaccination for those 60 years of age and older,
including those who have experienced previous episodes of shingles.

Publication Types: 
    Review

PMID: 17594207 [PubMed - indexed for MEDLINE]

189: MMWR Recomm Rep. 2007 Jun 22;56(RR-4):1-40.

Prevention of varicella: recommendations of the Advisory Committee on
Immunization Practices (ACIP).

Marin M, Guris D, Chaves SS, Schmid S, Seward JF; Advisory Committee on
Immunization Practices, Centers for Disease Control and Prevention (CDC).

Division of Viral Diseases, National Center for Immunization and Respiratory
Diseases, CDC, Atlanta, GA 30333, USA. mmarin@cdc.gov

Two live, attenuated varicella zoster virus-containing vaccines are available in 
the United States for prevention of varicella: 1) a single-antigen varicella
vaccine (VARIVAX, Merck & Co., Inc., Whitehouse Station, New Jersey), which was
licensed in the United States in 1995 for use among healthy children aged > or = 
12 months, adolescents, and adults; and 2) a combination measles, mumps, rubella,
and varicella vaccine (ProQuad, Merck & Co., Inc., Whitehouse Station, New
Jersey), which was licensed in the United States in 2005 for use among healthy
children aged 12 months-12 years. Initial Advisory Committee on Immunization
Practices (ACIP) recommendations for prevention of varicella issued in 1995 (CDC.
Prevention of varicella: recommendations of the Advisory Committee on
Immunization Practices [ACIP]. MMWR 1996;45 [No. RR-11]) included routine
vaccination of children aged 12-18 months, catch-up vaccination of susceptible
children aged 19 months-12 years, and vaccination of susceptible persons who have
close contact with persons at high risk for serious complications (e.g.,
health-care personnel and family contacts of immunocompromised persons). One dose
of vaccine was recommended for children aged 12 months-12 years and 2 doses, 4-8 
weeks apart, for persons aged > or = 13 years. In 1999, ACIP updated the
recommendations (CDC. Prevention of varicella: updated recommendations of the
Advisory Committee on Immunization Practices [ACIP]. MMWR 1999;48 [No. RR-6]) to 
include establishing child care and school entry requirements, use of the vaccine
following exposure and for outbreak control, use of the vaccine for certain
children infected with human immunodeficiency virus, and vaccination of
adolescents and adults at high risk for exposure or transmission. In June 2005
and June 2006, ACIP adopted new recommendations regarding the use of live,
attenuated varicella vaccines for prevention of varicella. This report revises,
updates, and replaces the 1996 and 1999 ACIP statements for prevention of
varicella. The new recommendations include 1) implementation of a routine 2-dose 
varicella vaccination program for children, with the first dose administered at
age 12-15 months and the second dose at age 4-6 years; 2) a second dose catch-up 
varicella vaccination for children, adolescents, and adults who previously had
received 1 dose; 3) routine vaccination of all healthy persons aged > or = 13
years without evidence of immunity; 4) prenatal assessment and postpartum
vaccination; 5) expanding the use of the varicella vaccine for HIV-infected
children with age-specific CD4+ T lymphocyte percentages of 15%-24% and
adolescents and adults with CD4+ T lymphocyte counts > or = 200 cells/microL; and
6) establishing middle school, high school, and college entry vaccination
requirements. ACIP also approved criteria for evidence of immunity to varicella.

Publication Types: 
    Practice Guideline

PMID: 17585291 [PubMed - indexed for MEDLINE]

190: J Virol. 2007 Sep;81(17):9024-33. Epub 2007 Jun 20.

Genetic analysis of varicella-zoster virus ORF0 to ORF4 by use of a novel
luciferase bacterial artificial chromosome system.

Zhang Z, Rowe J, Wang W, Sommer M, Arvin A, Moffat J, Zhu H.

Department of Microbiology and Molecular Genetics, UMDNJ-New Jersey Medical
School, 225 Warren Street, Newark, NJ 07101-1709, USA.

To efficiently generate varicella-zoster virus (VZV) mutants, we inserted a
bacterial artificial chromosome (BAC) vector in the pOka genome. We showed that
the recombinant VZV (VZV(BAC)) strain was produced efficiently from the BAC DNA
and behaved indistinguishably from wild-type virus. Moreover, VZV's
cell-associated nature makes characterizing VZV mutant growth kinetics difficult,
especially when attempts are made to monitor viral replication in vivo. To
overcome this problem, we then created a VZV strain carrying the luciferase gene 
(VZV(Luc)). This virus grew like the wild-type virus, and the resulting
luciferase activity could be quantified both in vitro and in vivo. Using
PCR-based mutagenesis, open reading frames (ORF) 0 to 4 were individually deleted
from VZV(Luc) genomes. The deletion mutant viruses appeared after transfection
into MeWo cells, except for ORF4, which was essential. Growth curve analysis
using MeWo cells and SCID-hu mice indicated that ORF1, ORF2, and ORF3 were
dispensable for VZV replication both in vitro and in vivo. Interestingly, the
ORF0 deletion virus showed severely retarded growth both in vitro and in vivo.
The growth defects of the ORF0 and ORF4 mutants could be fully rescued by
introducing wild-type copies of these genes back into their native genome loci.
This work has validated and justified the use of the novel luciferase VZV BAC
system to efficiently generate recombinant VZV variants and ease subsequent viral
growth kinetic analysis both in vitro and in vivo.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17581997 [PubMed - indexed for MEDLINE]

191: Clin Pediatr (Phila). 2007 Sep;46(7):646-9. Epub 2007 Jun 19.

Herpes zoster in an infant.

Dent AE, Baetz-Greenwalt BA.

Rainbow Babies and Children's Hospital, Department of Pediatrics, Division of
Pediatric Infectious Diseases and Rheumatology, Cleveland, Ohio 44106, USA.
arlene.dent@case.edu

Publication Types: 
    Case Reports

PMID: 17579095 [PubMed - indexed for MEDLINE]

192: Acta Paediatr. 2007 Jul;96(7):1099-100.

Consequences of varicella in pregnancy: a report of four cases.

Narkeviciute I.

Clinic of Children's Diseases of Vilnius University, Vilnius, Lithuania.
irena.narkeviciute@vuvl.lt

Four infants are reported with varicella-Zoster virus (VZV) infection, whose
mothers had varicella during the second-third trimester of pregnancy. Two
newborns had neonatal varicella. One of them, whose mother contracted varicella 5
days before delivery, had a severe and complicated form of the disease. The
infants who had herpes zoster did not have specific VZV-IgG antibodies at the
onset of the disease. CONCLUSION: These cases showed that varicella during the
second-third trimester of pregnancy may have serious consequence for infants.

Publication Types: 
    Case Reports

PMID: 17577346 [PubMed - indexed for MEDLINE]

193: Clin J Pain. 2007 Jul-Aug;23(6):490-6.

The impact of acute herpes zoster pain and discomfort on functional status and
quality of life in older adults.

Schmader KE, Sloane R, Pieper C, Coplan PM, Nikas A, Saddier P, Chan IS, Choo P, 
Levin MJ, Johnson G, Williams HM, Oxman MN.

Duke University, Durham, NC, USA. schma001@mc.duke.edu

OBJECTIVES: To describe the interference of herpes zoster (HZ) pain and
discomfort with activities of daily living (ADLs) and health-related quality of
life (HRQL) during the acute rash phase, and to quantify the relationship between
acute HZ pain and discomfort and impaired ADLs and HRQL in older persons.
METHODS: Prospective, observational study of 160 HZ outpatients age > or =60 at 4
US study sites who completed the Zoster Brief Pain Inventory (ZBPI), Zoster
Impact Questionnaire (ZIQ), McGill Pain Questionnaire, EuroQol, and SF-12
questionnaires on a predetermined schedule. Patients rated interference on a 0 to
10 scale for ADL items in the ZBPI and the ZIQ. Interference scores were averaged
to create summary measures for the ZBPI items (ZBPI ADLI) and ZIQ items (ZIQ
ADLI). A composite pain score was used in mixed-effects models analyses of the
association between pain and discomfort and ADLI and HRQL measures during the
first 35 days after HZ rash onset. RESULTS: HZ pain interfered with all ADLs but 
interference was greatest for enjoyment of life, sleep, general activity, leisure
activities, getting out of the house, and shopping. For every 1.0 point increase 
in pain and discomfort intensity, there was a 0.69 and 0.53 point increase in
ZBPI and ZIQ interference, respectively, and a 2.81 point, 1.57 point, and 1.95
point decrease in EuroQol, SF-12 physical, and SF-12 mental scales, respectively.
DISCUSSION: Acute zoster pain and discomfort has a significant negative impact on
functional status and HRQL in older adults. The magnitude of interference
increases with increasing pain and discomfort intensity.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17575488 [PubMed - indexed for MEDLINE]

194: BMC Infect Dis. 2007 Jun 15;7:59.

Varicella and herpes zoster in Madrid, based on the Sentinel General Practitioner
Network: 1997-2004.

Perez-Farinos N, Ordobas M, Garcia-Fernandez C, Garcia-Comas L, Canellas S,
Rodero I, Gutierrez-Rodriguez A, Garcia-Gutierrez J, Ramirez R.

Department of Epidemiology, Madrid Public Health Institute, Julian Camarillo 4B, 
Madrid, Spain. napoleon.perez@salud.madrid.org

BACKGROUND: Varicella (chickenpox) is the primary disease caused by
varicella-zoster virus. It is extremely contagious and is frequent in children.
Indeed, in the absence of vaccination, a high proportion of the population is
liable to contract it. Herpes zoster -more frequent among adults- is caused by
reactivation of the latent virus. The objective of this study is to describe the 
status of and time trend for varicella and herpes zoster in the Madrid Autonomous
Region prior to the introduction of the vaccine to the general population.
METHODS: Data source: individualised varicella and herpes zoster case records
kept by the Madrid Autonomous Region Sentinel General Practitioner Network for
the period 1997-2004. Cumulative incidences, crude and standardised incidence
rates, and age-specific rates of varicella and herpes zoster were calculated for 
each year. Kendall's Tau-b correlation coefficient was calculated to evaluate
whether incidence displayed a time trend. Spectral density in the time series of 
weekly incidences was estimated using a periodogram. RESULTS: Standardised annual
varicella incidence rates ranged from 742.5 (95% CI: 687.2-797.7) to 1239.6 (95% 
CI: 1164.5-1313.4) cases per 100 000 person-years. Most cases affected children, 
though complications were more frequent in adults. Varicella incidence displayed 
an annual periodicity but no trend over time. Most herpes zoster cases occurred
at advanced ages, with incidence registering a rising annual trend but no
seasonality factor. CONCLUSION: In the absence of vaccination, no significant
changes in varicella incidence were in evidence recent years, though these were
observed in the incidence of herpes zoster. Sentinel general practitioner
networks are a valid instrument for surveillance of diseases such as varicella.
Further varicella vaccination-coverage and vaccine-efficacy studies are called
for.

PMID: 17570859 [PubMed - indexed for MEDLINE]

195: Rev Soc Bras Med Trop. 2007 Mar-Apr;40(2):234-5.

Abdominal wall protrusion following herpes zoster.

Ruiz Junior FB, Shinosaki JS, Marques Junior W, Ferreira MS.

Servico de Neurologia, Hospital das Clinicas, Universidade Federal de Uberlandia,
Uberlandia, MG. facundo_burgos@uol.com.br

We present the case of a 62-year-old woman with abdominal segmental paresis
consequent to radiculopathy caused by zoster, which was confirmed by
electroneuromyography. The paresis resolved completely within three months.
Recognition of this complication caused by zoster, which is easily misdiagnosed
as abdominal herniation, is important for diagnosing this self-limited condition 
and avoiding unnecessary procedures.

Publication Types: 
    Case Reports

PMID: 17568896 [PubMed - indexed for MEDLINE]

196: Swiss Med Wkly. 2007 May 5;137(17-18):239-51.

Swiss recommendations for the management of varicella zoster virus infections.

Kempf W, Meylan P, Gerber S, Aebi C, Agosti R, Buchner S, Coradi B, Garweg J,
Hirsch H, Kind C, Lauper U, Lautenschlager S, Reusser P, Ruef C, Wunderli W,
Nadal D.

Dermatologische Klinik, Universitatsspital Zurich, CH-8091 Zurich, Switzerland.
kempf@derm.unizh.ch

Infections with varicella zoster virus (VZV) are common viral infections
associated with significant morbidity. Diagnosis and management are complex,
particularly in immunocompromised patients and during pregnancy. The present
recommendations have been established by a multidisciplinary panel of specialists
and endorsed by numerous Swiss medical societies involved in the medical care of 
such patients (Appendix). The aim was to improve the care of affected patients
and to reduce complications.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17557214 [PubMed - indexed for MEDLINE]

197: Nurse Pract. 2007 Jun;32(6):6-7.

Prevent shingles with Zostavax.

Laustsen G, Neilson T.

Oregon Health and Science University, School of Nursing, La Grande, OR, USA.

PMID: 17557014 [PubMed - indexed for MEDLINE]

198: BMJ. 2007 Jun 9;334(7605):1211-5.

Herpes zoster.

Wareham DW, Breuer J.

Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and
the London, Queen Mary's School of Medicine and Dentistry. d.w.wareham@qmul.ac.uk

Publication Types: 
    Review

PMID: 17556477 [PubMed - indexed for MEDLINE]

199: J Clin Virol. 2007 Jul;39(3):238-9. Epub 2007 Jun 6.

Comment on:
    J Clin Virol. 2007 Apr;38(4):275-9.

Correlates of acute pain in herpes zoster.

Opstelten W, van Loon AM, van Wijck AJ, Moons KG.

Publication Types: 
    Comment
    Letter

PMID: 17556015 [PubMed - indexed for MEDLINE]

200: Ophthalmologe. 2007 Jun 5 [Epub ahead of print]

[Scleromalacia associated with varicella-zoster virus.]

[Article in German]

Yoeruek E, Deuter CM, Szurman P, Tatar O, Zierhut M.

Abteilung I, Universitatsaugenklinik der Eberhard-Karls-Universitat Tubingen,
Schleichstra?e 12, 72076, Tubingen, Deutschland,
Efdal.Yoeruek@med.uni-tuebingen.de.

BACKGROUND: Scleromalacia usually appears following vasculitis in systemic
rheumatoid diseases, especially as a late symptom of rheumatoid arthritis. CASE
REPORT: A 67-year-old woman was referred to our hospital for further evaluation
with the diagnosis of a "fast-growing tumor" of the left eye. Sixteen months ago 
she had suffered from herpes zoster ophthalmicus-associated keratouveitis and
trabeculitis in the same eye. Scleromalacia associated with varicella-zoster
virus (VZV) was diagnosed after the biomicroscopic and gonioscopic examination of
the eye was completed and a systemic disease had been ruled out. One week after
beginning systemic application of acyclovir (5x800 mg daily) and prednisolone (30
mg daily), the anterior chamber inflammation regressed and a fibrosis seemed to
appear in the atrophic scleral area. CONCLUSION: Although scleral atrophy mostly 
appears as a late sign of systemic rheumatoid diseases, it might also develop
secondary to infectious diseases. Scleromalacia associated with varicella-zoster 
virus has been previously described only in a few cases. Scleromalacia is a
vision-threatening complication of zoster ophthalmicus which responds well to
combination therapy with systemic antiviral and anti-inflammatory agents.

PMID: 17549494 [PubMed - as supplied by publisher]

201: Otolaryngol Head Neck Surg. 2007 Jun;136(6):1027.

Comment on:
    Otolaryngol Head Neck Surg. 2007 Feb;136(2):313-4.

Hutchinson sign and herpes zoster.

Opstelten W, Zaal MJ.

Publication Types: 
    Comment
    Letter

PMID: 17548004 [PubMed - indexed for MEDLINE]

202: J Vestib Res. 2006;16(4-5):217-22.

The lesion site of vestibular dysfunction in Ramsay Hunt syndrome: a study by
click and galvanic VEMP.

Ozeki H, Iwasaki S, Ushio M, Takeuchi N, Murofushi T.

Department of Otolaryngology and Head and Neck Surgery, University of Tokyo,
Tokyo, Japan.

Ramsay Hunt syndrome (RHS) is characterized by vestibulocochlear dysfunction in
addition to facial paralysis and auricular vesicles. The present study
investigated the lesion site of vestibular dysfunction in a group of 10 RHS
patients. Caloric testing, vestibular evoked myogenic potentials by click sound
(cVEMP) and by galvanic stimulation (gVEMP) were used to assess the function of
the lateral semicircular canal, saccule, and their afferents. The results of
caloric testing (all 10 cases showed canal paresis) mean the existence of lesion 
sites in lateral semicircular canal and/or superior vestibular nerve (SVN).
Abnormal cVEMPs in 7 patients mean the existence of lesions in saccule and/or
inferior vestibular nerve (IVN). Four of the 6 patients with absent cVEMP also
underwent gVEMP. The results of gVEMP (2 absent and 2 normal) mean that the
former 2 have lesions of the vestibular nerve, and the latter 2 have only
saccular lesions concerning the pathway of VEMPs. Thus, our study suggested that 
lesion sites of vestibular symptoms in RHS could be in the vestibular nerve
and/or labyrinth, and in SVN and/or IVN. In other words, in the light of
vestibular symptoms, there is the diversity of lesion sites.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17538211 [PubMed - indexed for MEDLINE]

203: Acta Paediatr. 2007 Jun;96(6):794-5.

Comment on:
    Acta Paediatr. 2007 Jun;96(6):861-3.

General vaccination of children against varicella?--Yes!

Trollfors B.

Birger East Hospital, Goteborg 41685, Sweden. birger.trollfors@vgregion.se

Publication Types: 
    Comment

PMID: 17537004 [PubMed - indexed for MEDLINE]

204: Community Pract. 2007 May;80(5):9.

Shingles.

Wyndham M.

PMID: 17536461 [PubMed - indexed for MEDLINE]

205: Eur J Epidemiol. 2007;22(6):405-9. Epub 2007 May 30.

Seroprevalence of varicella antibodies among pregnant women in Lyon-France.

Saadatian-Elahi M, Mekki Y, Del Signore C, Lina B, Derrough T, Caulin E, Thierry 
J, Vanhems P.

Laboratoire d'Epidemiologie et de Sante Publique, Universite de Lyon, F-69003,
Lyon, France.

The purpose of the study was to calculate the seroprevalence of immunity to the
varicella-zoster virus (VZV) infection and to evaluate the positive predictive
value (PPV) and the negative predictive value (NPV) of the self-reported history 
of VZV infection in pregnant women. A cross sectional study was conducted in 18
private medical analysis laboratories. Information on socio-demographic
characteristics and past history of varicella or zoster were collected using a
questionnaire. Blood samples were obtained to determine the serological levels of
past exposure to VZV. Overall, 486 pregnant women were recruited. The
seroprevalence of VZV antibodies was 98.8%. Six women were seronegative, of whom 
four were primiparous. The PPV was high (99.5%) while the NPV was only 10.3%. The
PPV is a reliable marker of prior VZV infection. In contrast, a negative history 
does not predict lack of immunity and should be completed by serological analysis
which might be introduced to routine antenatal blood tests.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17534728 [PubMed - indexed for MEDLINE]

206: Sex Health. 2007 Jun;4(2):141-2.

Famciclovir or valaciclovir in the management of herpes simplex and varicella
zoster infections: an attitudinal survey of clinician perceptions of differential
activity.

Smith DE, Gold J.

Publication Types: 
    Letter

PMID: 17524295 [PubMed - indexed for MEDLINE]

207: Am J Dermatopathol. 2007 Jun;29(3):303-5.

Zosteriform connective tissue nevus: a case report.

Amjadi M, Khorrami-Arani N, Mashman G, Allen PW.

School of Medicine, Flinders University of South Australia, South Australia,
Australia. amja0002@flinders.edu.au

Zosteriform connective tissue nevus is a rare form of connective tissue
hamartomas, which arises from cells of mesodermal origin. Despite similar
clinical appearance of many connective tissue nevi, they can be differentiated
histochemically and/or biochemically on the basis of the primary connective
tissue element present. There are only 3 reported cases of zosteriform connective
tissue nevi in the worldwide literature. We report a case occurring in a
25-year-old male with approximately 40 nodules and smaller papules distributed in
a zosteriform fashion on the right lower lumbar region and upper gluteal region. 
The identification of the lesion by deep biopsy excluded the important
differential diagnosis of segmental neurofibromatosis.

Publication Types: 
    Case Reports

PMID: 17519633 [PubMed - indexed for MEDLINE]

208: J Med Virol. 2007 Jul;79(7):1025-31.

Different genotype pattern of varicella-zoster virus obtained from patients with 
varicella and zoster in Germany.

Sauerbrei A, Wutzler P.

Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of
Jena, Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de

The general use of the varicella vaccine requires the surveillance of
varicella-zoster virus (VZV) strains in patients infected with VZV. This paper
reports the data achieved from a prospective study of genotyping VZV in Germany, 
analyzing the restriction fragment length polymorphism (RFLP) of the open reading
frames (ORF) 38, 54, and 62 as well as the polymorphism of the R5 repeat region. 
The study included 177 patients with varicella. Seventy-eight patients with
zoster served as controls. Results revealed that 78% of VZV strains in patients
with varicella had the genetic profile of the dominant wild-genotype occurring in
Europe and 22% had the markers of African or Asian strains. Varicella patients
with the profile of African or Asian strains were significantly younger than
patients with varicella caused by the dominant genotype. By contrast, all zoster 
patients exhibited strains representing the majority of wild-type strains in
Europe. In conclusion, VZV strains from patients with varicella have a
significantly higher genetic variability than viral strains from zoster patients.
Since variants with the markers of African or Asian strains could only be found
in young children with chickenpox, the results suggest a changing scene of VZV
genotypes in Germany. As reasons, the spread of viruses, which may be imported
originally by persons immigrating from warmer climates, or the recombination
between wild-and vaccine-type viruses have to be considered.

Publication Types: 
    Comparative Study

PMID: 17516537 [PubMed - indexed for MEDLINE]

209: Pract Neurol. 2007 Jun;7(3):182-5.

Some syndromes of James Ramsay Hunt.

Pearce JM.

Emeritus Department of Neurology, Hull Royal Infirmary, Hull, UK.
jmsp@freenet.co.uk

Publication Types: 
    Historical Article
    Review

PMID: 17515597 [PubMed - indexed for MEDLINE]

210: Blood. 2007 Oct 15;110(8):3071-7. Epub 2007 May 21.

One-year acyclovir prophylaxis for preventing varicella-zoster virus disease
after hematopoietic cell transplantation: no evidence of rebound varicella-zoster
virus disease after drug discontinuation.

Erard V, Guthrie KA, Varley C, Heugel J, Wald A, Flowers ME, Corey L, Boeckh M.

Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle,
WA 98109-1024, USA.

No consensus exists on whether acyclovir prophylaxis should be given for
varicella-zoster virus (VZV) prophylaxis after hematopoietic cell transplantation
because of the concern of "rebound" VZV disease after discontinuation of
prophylaxis. To determine whether rebound VZV disease is an important clinical
problem and whether prolonging prophylaxis beyond 1 year is beneficial, we
examined 3 sequential cohorts receiving acyclovir from day of transplantation
until engraftment for prevention of herpes simplex virus reactivation (n = 932); 
acyclovir or valacyclovir 1 year (n = 1117); or acyclovir/valacyclovir for at
least 1 year or longer if patients remained on immunosuppressive drugs (n = 586).
In multivariable statistical models, prophylaxis given for 1 year significantly
reduced VZV disease (P < .001) without evidence of rebound VZV disease.
Continuation of prophylaxis beyond 1 year in allogeneic recipients who remained
on immunosuppressive drugs led to a further reduction in VZV disease (P = .01)
but VZV disease developed in 6.1% during the second year while receiving this
strategy. In conclusion, acyclovir/valacyclovir prophylaxis given for 1 year led 
to a persistent benefit after drug discontinuation and no evidence of a rebound
effect. To effectively prevent VZV disease in long-term hematopoietic cell
transplantation survivors, additional approaches such as vaccination will
probably be required.

Publication Types: 
    Clinical Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17515400 [PubMed - indexed for MEDLINE]

211: J Cutan Med Surg. 2007 May-Jun;11(3):89-98.

Open-label study of valacyclovir 1.5 g twice daily for the treatment of
uncomplicated herpes zoster in immunocompetent patients 18 years of age or older.

Madkan VK, Arora A, Babb-Tarbox M, Aboutlabeti S, Tyring S.

Department of Dermatology, University of Texas School of Medicine, Center for
Clinical Studies, Houston, TX 77030, USA.

BACKGROUND: Herpes zoster (shingles) is a common disease caused by a reactivation
of the latent varicella-zoster virus (chickenpox), which resides in the dorsal
root ganglia. Valacyclovir HCl, the L-valyl ester of acyclovir, is an antiviral
drug that is used to accelerate the resolution of the herpes zoster rash and
associated pain and reduce the duration of postherpetic neuralgia. OBJECTIVE: To 
demonstrate the safety and efficacy of oral valacyclovir 1.5 g twice daily (bid) 
for the treatment of uncomplicated herpes zoster in immunocompetent patients over
18 years of age. The dosing schedule of bid versus three times daily is desirable
for enhancing patient compliance and to subsequently reduce the incidence of
viral resistance. METHODS: One treatment group of 125 patients was administered
oral valacyclovir 1.5 g bid for 7 days. Administration of the first dose occurred
within 72 hours after onset of rash. Patients were seen and assessed for
cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated
abnormal sensations (ZAAS). Patients under 50 years of age were followed for 4
weeks and patients 50 years of age and older were followed for a total of 24
weeks. Patients >or= 50 years were also asked to record a daily diary on pain and
abnormal sensations throughout the 24-week study period. Responses to resource
use and quality of life questions were also collected. Safety was monitored by
means of routine hematologic and biochemical assessments and reporting of adverse
experiences. RESULTS: Data from this study were compared with historical control 
groups both for three times daily antiviral therapy and for placebo. The results 
showed that twice-daily dosing was as safe and effective as three times daily
dosing for the reduction of ZAP and ZAAS. Adverse-effect profiles were similar
between the two different regimens, and both treatment groups showed better
outcomes than the historical placebo group. Because it is standard of care to
administer antivirals for the treatment of acute herpes zoster, a
placebo-controlled trial is not possible, necessitating the use of historical
controls. CONCLUSION: Oral valacyclovir 1.5 g bid is safe and effective for the
treatment of uncomplicated herpes zoster in immunocompetent patients over 18
years of age. Twice-daily dosing may help increase patient compliance and
therefore increase the effectiveness of treatment of the acute herpes zoster rash
and the prevention of ZAP.

Publication Types: 
    Clinical Trial
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17511925 [PubMed - indexed for MEDLINE]

212: Rinsho Shinkeigaku. 2007 Feb-Mar;47(2-3):105-8.

[Case of Horner's syndrome associated with ophthalmic herpes zoster]

[Article in Japanese]

Kobayashi Y, Yamamoto T.

Department of Rehabilitation, Fukui General Hospital.

We reported a 74-year-old man with right Horner's syndrome associated with
ophthalmic herpes zoster. He presented acute onset of pain, swelling, vesicular
cutaneous eruption around the right eyelid. A diagnosis of herpes zoster
ophthalmicus was made and he was started on acyclovir 750 mg/day. Seven days
later he manifested right abduction deficit On admission nine days later, the
right eyelid became ptotic and the right pupil was smaller than the left There
was gradual improvement over the next 10 days in ptosis and miosis, and over the 
next 3 weeks in the right abduction deficit. As the sympathetic nerve runs with
the carotid artery, it partially joins the sixth nerve within the cavernous
sinus. We have identified a patient in whom herpes zoster ophthalmicus has
resulted in a syndrome involving the sympathetic nerves, the sixth nerve, and the
first division of the fifth cranial nerve. As the Horner's syndrome was
transient, we might miss the symptom in the early stage, so we should carefully
examine the patients.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17511278 [PubMed - indexed for MEDLINE]

213: Minerva Ginecol. 2007 Apr;59(2):159-74.

Viral infections in pregnancy.

Haun L, Kwan N, Hollier LM.

Division of Maternal-Fetal Medicine, Department of Obstetrics, University of
Texas-Houston Medical School, Lyndon Baines Johnson General Hospital, 5656 Kelley
Street, Houston, TX 77026, USA.

Viral infections are a common complication of pregnancy and in some cases, can
have profound effects for the unborn fetus. The human herpesvirus family is
composed of large, enveloped DNA viruses that have close structural similarity.
The family includes the herpes simplex viruses types 1 and 2, varicella zoster
virus, Epstein Barr virus, cytomegalovirus (CMV), and human herpes viruses types 
6, 7 and 8. These viruses all share the ability to establish latency and
reactivate at a later time. Structural fetal abnormalities can result from
intrauterine infection and transmission of the infection during the pregnancy or 
at the time of delivery can result in important neonatal disease. Human
parvovirus B19 is a DNA virus with strong tropism for erythroid precursors and
infection during pregnancy can result in fetal hydrops and stillbirth. The
causative agents of hepatitis are hepatotropic viruses termed hepatitis A, B, C, 
D (deltavirus) and E. All except hepatitis B virus are RNA viruses. Vertical
transmission of maternal infection with hepatitis B and C can result in
significant long term sequelae.

Publication Types: 
    Review

PMID: 17505458 [PubMed - indexed for MEDLINE]

214: Br J Ophthalmol. 2007 Nov;91(11):1452-5. Epub 2007 May 15.

Acute retinal necrosis: a national population-based study to assess the
incidence, methods of diagnosis, treatment strategies and outcomes in the UK.

Muthiah MN, Michaelides M, Child CS, Mitchell SM.

The Western Eye Hospital, Marylebone Road, London NW1 5YE, UK.

AIM: To determine the incidence, methods of diagnosis, treatment strategies and
outcomes for acute retinal necrosis (ARN) in the UK. METHODS: A 12-month active
case ascertainment study was carried out between March 2001 and March 2002 to
record cases of ARN presenting to ophthalmologists via the British
Ophthalmological Surveillance Unit (BOSU) reporting system. Questionnaires were
sent to the reporting consultants, requesting data on patient characteristics,
presentation, clinical findings, investigations and treatment. Diagnosis was made
using the American Uveitis Society diagnostic criteria. Further questionnaires
were sent at 2 weeks and 6 months to assess outcome and therapies. RESULTS: 74
cases of ARN were reported by 58 consultants between March 2001 and March 2002.
Questionnaires were returned for 49 cases (66.2%), of which 18 (36.7%) were
excluded. Of the 31 cases included, 22 (71.0%) were male and 9 (29.0%) were
female. The age range was 13 to 85 years (mean 54.3 years). 28 cases (90.3%) were
unilateral, with 3 patients (9.7%) presenting with bilateral ARN. An aqueous or
vitreous biopsy was performed in only 18 patients, with one patient having both. 
Herpes viral DNA analysis was performed on all 19 biopsies, with identification
of the viral DNA in 16; results from 3 biopsies were not documented. Varicella
zoster virus (VZV) was the commonest cause identified in 10 patients (56%). Of
the 31 subjects, 27 (87.1%) were treated for ARN with systemic antiviral
treatment: with intravenous antiviral in 23 cases (85.2%) and oral antiviral in 4
cases (14.8%). 21 of these patients went on to receive oral antiviral maintenance
therapy. In addition to antiviral treatment, systemic steroids were given to 16
subjects (51.6%). Surgical intervention for retinal detachment was performed on 5
patients. CONCLUSIONS: During the 12-month study period, 31 cases of ARN met the 
diagnostic criteria set by the American Uveitis Society. The incidence in the UK 
based on this study is approximately 1 case per 1.6 to 2.0 million population per
year. We have ascertained that the management of ARN throughout the UK is
variable, suggesting that national guidelines would be of benefit.

Publication Types: 
    Multicenter Study

PMID: 17504853 [PubMed - indexed for MEDLINE]

215: Headache. 2007 May;47(5):728-30.

Sympathetic nerve blocks in mandibular herpes zoster and postherpetic neuralgia.

Gomes RT, de Nazareth Pedras RB, da Silva JF, de Aguiar MC.

Pain Clinic, Hospital das Clinicas Federal, University of Minas Gerais, Belo
Horizonte, MG, Brazil.

Sympathetic blocks have been indicated for the diagnosis and treatment of painful
neuropathic conditions, such as herpes zoster (HZ) and postherpetic neuralgia
(PHN). The purpose of this article is to report a case of mandibular HZ and PHN
in an HIV-positive patient, and discuss the efficacy of sympathetic nerve blocks 
for pain relief and prevention of PHN.

PMID: 17501858 [PubMed - indexed for MEDLINE]

216: Dermatol Online J. 2007 May 1;13(2):2.

Why do so many clinicians believe that recurrent zoster is common?

Chien AJ, Olerud JE.

The University of Washington Department of Medicine, Division of Dermatology,
Seattle, USA. andchien@u.washington.edu

PMID: 17498421 [PubMed - indexed for MEDLINE]

217: Nippon Rinsho. 2007 Mar 28;65 Suppl 3:326-30.

[Varicella-zoster virus infection]

[Article in Japanese]

Suzuki K, Suga S, Asano Y.

Department of Pediatrics, Toyokawa City Hospital.

Publication Types: 
    Review

PMID: 17494161 [PubMed - indexed for MEDLINE]

218: Wien Klin Wochenschr. 2007;119(7-8):217.

Hemorrhagic herpes zoster.

Steininger C, Huber J, Hauswirth A.

Department of Medicine I, Medical University Vienna, Vienna, Austria.
christoph.steininger@meduniwien.ac.at

Publication Types: 
    Case Reports

PMID: 17492347 [PubMed - indexed for MEDLINE]

219: J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S8-S13.

Management strategies for herpes zoster and postherpetic neuralgia.

Galluzzi KE.

Philadelphia College of Osteopathic Medicine, 4190 City Avenue, Philadelphia, PA 
19131-1633, USA. katherineg@pcom.edu

Evidence-based strategies for the management of herpes zoster and postherpetic
neuralgia (PHN) include the use of antiviral agents in acute zoster and specific 
analgesics in PHN. Antiviral agents are effective in reducing the severity and
duration of acute herpes zoster when given within 72 hours of rash onset, but
they do not prevent PHN. Anticonvulsants, tricyclic antidepressants, opioids, and
topical treatment modalities such as lidocaine-containing patches and capsaicin
cream offer moderate pain relief to some patients with PHN, but they may be
associated with adverse events that limit their use. Therefore, prevention of
herpes zoster and PHN with prophylactic vaccination using the zoster virus
vaccine is an effective strategy to reduce the morbidity of these conditions.
Treatment modalities are available, however, that may shorten the duration of
acute herpes zoster and alleviate the pain of PHN.

Publication Types: 
    Review

PMID: 17488885 [PubMed - indexed for MEDLINE]

220: J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S2-7.

The burden of herpes zoster and postherpetic neuralgia in the United States.

Weaver BA.

Armor Correctional Health Services, Hillsborough County Jail Medical Clinic, 520 
Falkenburg Road, Tampa, FL 33619, USA. bethanyg@myuw.net

Herpes zoster (shingles), a painful and disabling disease, affects an estimated 1
million individuals in the United States annually and results in significant
morbidity, lost productivity, and diminished quality of life. Herpes zoster
constitutes the reactivation of varicella-zoster virus (VZV), the same virus that
causes chickenpox. After resolution of chickenpox, VZV remains dormant in dorsal 
root ganglia. Varicella-zoster-specific cell-mediated immunity wanes naturally
with advancing age or earlier in the setting of an altered immune status, which
can result in the reactivation of VZV as herpes zoster. The pain associated with 
the rash caused by herpes zoster is often described as burning, stabbing,
itching, or aching. Postherpetic neuralgia, the most common complication of
herpes zoster, occurs after the zoster rash has resolved, affecting up to a third
of patients. Herpes zoster is associated with significant morbidity, especially
in the elderly. Herpes zoster is both more common and more severe among older
adults. In both acute herpes zoster and postherpetic neuralgia, pain is the
primary cause of morbidity.

Publication Types: 
    Review

PMID: 17488884 [PubMed - indexed for MEDLINE]

221: J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S14-8.

Herpes zoster vaccine: clinical trial evidence and implications for medical
practice.

Burke MS.

Internal Medicine Clinical Care Center, Lankenau Hospital, 100 Lancaster Avenue, 
Area B15, Wynnewood, PA 19096-3450, USA. burkes@mlhs.org

This review of the data from the Shingles Prevention Study (SPS) highlights the
efficacy and safety of a high-titer live attenuated herpes zoster virus vaccine
in preventing herpes zoster and postherpetic neuralgia (PHN) in adults aged 60
years or older. In the SPS, the vaccine reduced the burden of illness due to
herpes zoster disease by 61.1% and the incidence of its most common and
debilitating sequela, PHN, by 66.5%. In addition, vaccination was associated with
a 51.3% reduction in the overall incidence of herpes zoster. Also, subjects in
whom herpes zoster did develop had decreased pain and discomfort. The vaccine was
safe in the SPS population, with little differentiation from the safety profile
of placebo other than an increased risk for reactions at the injection site.
Rates of serious adverse events, systemic adverse events, hospitalization, and
death were low and similar to those observed in the group that received placebo.

Publication Types: 
    Review

PMID: 17488883 [PubMed - indexed for MEDLINE]

222: JAAPA. 2007 Apr;20(4):16.

New drug information. Product: Zostavax.

[No authors listed]

PMID: 17484325 [PubMed - indexed for MEDLINE]

223: Int J Hematol. 2007 Apr;85(3):242-5.

Quantification of circulating varicella-zoster virus DNA for follow-up in a case 
of visceral varicella-zoster infection ameliorated with intravenous acyclovir.

Ishizawa J, Fujita H, Iguchi M, Tachibana T, Taguchi J, Ishigatsubo Y.

Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan.

We describe a patient with acute lymphocytic leukemia (ALL) who developed
visceral varicella-zoster virus (VZV) infection following cord blood stem cell
transplantation (CBSCT) and was successfully treated with intravenous acyclovir
(ACV). A 24-year-old woman with ALL developed severe epigastric pain 168 days
after CBSCT, followed by blistering eruptions 2 days later. A diagnosis of
visceral varicella-zoster disease was made, and early intravenous ACV therapy
successfully alleviated the epigastric pain and skin lesions within 2 weeks.
Polymerase chain reaction analysis of the serum showed dramatic decreases in the 
viral DNA copy number and revealed large viral concentrations prior to the skin
manifestations. The viral DNA copy number in whole blood remained positive,
however, but was reduced. Further treatment with intravenous ACV led to VZV DNA
becoming undetectable in whole blood, a result not achieved with oral
valacyclovir.

Publication Types: 
    Case Reports

PMID: 17483062 [PubMed - indexed for MEDLINE]

224: Am J Prev Med. 2007 May;32(5):370-4.

Preventive misconception: its nature, presence, and ethical implications for
research.

Simon AE, Wu AW, Lavori PW, Sugarman J.

National Center for Health Statistics, Centers for Disease Control and
Prevention, Hyattsville, Maryland, USA.

BACKGROUND: Ethical aspects of prevention trials, as they differ from therapeutic
trials, have not been fully explored. This article aims to define and demonstrate
the existence of "preventive misconception" (PM), a misunderstanding in which
research participants in prevention trials make an "overestimate in probability
or level of personal protection that is afforded by being enrolled in a trial of 
a preventive intervention." METHODS: A rating tool was developed to evaluate PM, 
using data collected between August 2000 and July 2002 as part of a nationwide
study of the quality of informed consent in a trial of a shingles vaccine. During
2005-2006, two pair of raters assessed the responses of 50 participants to
questions asked after the participants had given consent to participate in the
shingles trial. Two pair of raters evaluated the response for the presence and
type of PM. Each pair of raters adjudicated their responses and inter-rater
reliability was assessed. RESULTS: Adjudicated pairs of raters agreed that 32%
(CI: 20.7%-45.9%) of participants showed evidence of PM (kappa=0.71, CI:
0.52-0.90); that 12% (CI: 5.2%-24.2%) of participants underestimated the
probability of receiving placebo (kappa=0.53, CI: 0.24-0.83); and that 24% (CI:
14.2%-37.6%) overestimated the likely personal effectiveness of the experimental 
intervention (kappa=0.42, CI: 0.08-0.76). CONCLUSIONS: This study newly describes
the concept of preventive misconception and empirically demonstrates its
existence in trials of prevention. Study participants may overestimate the
protection that they receive by being enrolled in a trial of prevention, which
poses ethical challenges for research.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17478261 [PubMed - indexed for MEDLINE]

225: Inflamm Bowel Dis. 2007 Sep;13(9):1178-9.

Comment on:
    Clin Gastroenterol Hepatol. 2006 Dec;4(12):1483-90.

Nailing down the shingles in IBD.

Kotton CN.

Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street Cox
5, Boston, MA 02114, USA.

Publication Types: 
    Comment

PMID: 17476676 [PubMed]

226: Int J Dermatol. 2007 May;46(5):500-2.

Localized linear IgA dermatosis induced by UV light-treatment for herpes zoster.

He C, Xu H, Xiao T, Geng L, Chen HD.

Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang, 
China.

We report a case of localized linear IgA dermatosis (LID). The patient suffered
from herpes zoster on the right waist and received three localized ultraviolet
(UV) light treatments. One month later he presented with bullae on the same site.
Direct immunofluorescence showed deposition of linear IgA and weak C3 along the
basement membrane zone. Indirect immunofluorescence on the salt-split human skin 
demonstrated that IgA antibodies were bound to the epidermal side. To our
knowledge, this is the first case of localized LID induced by UV light treatment 
for herpes zoster. It is also the third case of LID induced by UV light.

Publication Types: 
    Case Reports

PMID: 17472682 [PubMed - indexed for MEDLINE]

227: Holist Nurs Pract. 2007 May-Jun;21(3):124-34.

Postherpetic neuralgia in older adults: culture, quality of life, and the use of 
alternative/complementary therapies.

Young MK, Wood M, Jean-Noel N.

Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades
Road, Boca Raton, FL 33431, USA. myoung@pbiho.net

The purpose of this article is to describe current knowledge and standards of
care for postherpetic neuralgia (PHN) among older persons. Three influencing
factors are considered: cultural implications, quality of life (QOL), and current
practice of alternative/complementary therapy. A review of literature published
between 2001 and 2006 was conducted. The findings indicate that PHN has
debilitating effects on older adults regardless of culture. The impact of PHN on 
culture and ethnicity, particularly on the relationship between culture and
patient's self-report of herpes zoster and/or PHN, has not been well investigated
as evidenced in the literature. PHN is found to be associated with decreased
health-related QOL among the elderly, with the most affected domains being sleep,
mood, and general activity. Alternative and complementary therapy offers many
advantages such as ease of use, availability, and low cost. However, due to lack 
of controlled trials and insufficient evidence, alternative therapy is not
currently used widely and recommended. As the US population ages, the incidence
of herpes zoster and PHN is expected to rise. Clinical trials that explore the
response of the culturally diverse older adults to current treatment guidelines, 
strategies for prevention of PHN and its corresponding decrease in QOL, as well
as controlled trials of alternative/complementary remedies should be considered.

Publication Types: 
    Review

PMID: 17471050 [PubMed - indexed for MEDLINE]

228: J Cataract Refract Surg. 2007 May;33(5):925-6.

Spontaneous intraocular lens extrusion in a patient with scleromalacia secondary 
to herpes zoster ophthalmicus.

Ahmed TY, Carrim ZI, Diaper CJ, Wykes WN.

Department of Ophthalmology, Southern General Hospital, Glasgow, Scotland.
tahaahmed@doctors.org.uk

We report a case of spontaneous intraocular lens (IOL) extrusion in association
with scleromalacia 10 years after uneventful endocapsular surgery. The patient
had a history of iridocyclitis secondary to herpes zoster ophthalmicus in the
affected eye. A minimally invasive approach involving repositioning the IOL and
closure with a conjunctival flap resulted in restoration of visual acuity.

Publication Types: 
    Case Reports

PMID: 17466876 [PubMed - indexed for MEDLINE]

229: J Pediatr Gastroenterol Nutr. 2007 May;44(5):637-9.

Varicella recurrence complicated by pneumonia after liver transplantation for
APECED.

Batra A, Davison S, Rajwal S, Hale A, Stringer MD, McClean P.

Children's Liver & GI Unit, St James's University Hospital, Leeds, UK.

Publication Types: 
    Case Reports

PMID: 17460500 [PubMed - indexed for MEDLINE]

230: Korean J Ophthalmol. 2007 Mar;21(1):51-4.

Progressive outer retinal necrosis combined with vitreous hemorrhage in a patient
with acquired immunodeficiency syndrome.

You YS, Lee SJ, Lee SH, Park CH, Kwon OW.

NUNE Eye Hospital, Seoul, Korea.

PURPOSE: To describe an unusual case of rapidly progressive outer retinal
necrosis (PORN) with vitreous hemorrhage in a 41-year-old woman with acquired
immunodeficiency syndrome (AIDS), who had retinitis developed from what was
probably varicellar-zoster virus combined with cytomegalovirus (CMV) and herpes
simplex type 1,2, as proven by the polymerase chain reaction restriction fragment
length polymorphism method (PCR-RFLP). METHODS: This study is a case report
detailing clinical follow-up and an aqueous humor test by PCR-RFLP. RESULTS: The 
deep, white retinal lesions coalesced and progressively expanded in a
circumferential manner, with sparing of the perivascular retina. However, retinal
and vitreous hemorrhages, unusual findings for PORN, could be noted around the
optic nerve. Varicellar-zoster virus (VZV), cytomegalovirus (CMV), and herpes
simplex types 1,2 (HSV-1,2) were detected in the aqueous humor by PCR.
CONCLUSIONS: PORN has been described as a variant of necrotizing herpetic
retinopathy, occurring particularly in patients with AIDS. Although the etiologic
agent has been reported to be VZV, concurrent or combined etiologic agents can
include HSV-1, HSV-2, and CMV in AIDS patients. Therefore, combined antiviral
therapy with acyclovir and ganciclovir could be more reasonable as an initial
therapy.

Publication Types: 
    Case Reports

PMID: 17460434 [PubMed - indexed for MEDLINE]

231: Nippon Rinsho. 2007 Feb 28;65 Suppl 2 Pt. 1:480-6.

[Antiviral resistance of herpes simplex virus and varicella-zoster virus]

[Article in Japanese]

Daikoku T, Shiraki K.

Department of Virology, University of Toyama.

Publication Types: 
    Review

PMID: 17455667 [PubMed - indexed for MEDLINE]

232: Rev Chilena Infectol. 2007 Apr;24(2):106-10. Epub 2007 Apr 12.

[Erroneous prescriptions of aciclovir and valaciclovir in herpes zoster
treatment]

[Article in Spanish]

Fica C A, Jadue A C, Donaire R L.

Seccion de Infectologia, Hospital Clinico, Universidad de Chile, Departamento de 
Medicina, Santiago, Chile. afica@redclinicauchile.cl

Medical prescription errors are frequent in community settings and information
exploring its magnitude during antiviral treatment of herpes zoster is scarce. A 
questionnaire was applied to 31 physicians working in hospital- or
community-based settings in Santiago, Chile in order to characterize their dosing
and timing preferences for aciclovir or valaciclovir prescriptions. Aciclovir was
more often prescribed than valaciclovir (71.9 and 28.1%, respectively), but less 
than a third of prescription (27.3%) fulfilled the minimal aciclovir dosing and
timing criteria for clinical efficacy (4 gr per day and <72 hours since rash
initiation). The limited size of the simple prevented exploring factors linked to
a misleading prescription. Appropriate knowledge on dosing and timing of
aciclovir/valaciclovir therapy for herpes zoster was infrequent in a sample of
physicians working in various clinical settings in Chile.

Publication Types: 
    English Abstract

PMID: 17453067 [PubMed - indexed for MEDLINE]

233: Pain. 2007 Sep;131(1-2):214-8. Epub 2007 Apr 23.

Relief of post-herpetic neuralgia by surgical removal of painful skin: 5 years
later.

Petersen KL, Rowbotham MC.

UCSF Pain Clinical Research Center, Department of Neurology, University of
California, San Francisco, CA 94115, USA. karin.petersen@ucsf.edu

Surgical removal of painful skin was first attempted as a treatment for chronic
intractable post-herpetic neuralgia (PHN) more than a century ago, but long-term 
follow-up has rarely been reported. A patient who underwent surgical excision of 
294cm(2) of thoracic skin comprising the entire area of pain and allodynia in
October 2000 has been followed for 5.5years post-surgery. Our initial report
presented evidence of benefit in the form of reduced pain, elimination of
allodynia, and reduced medication consumption during the first post-operative
year. Unfortunately, pain steadily increased and now exceeds pre-surgery levels
despite increased medication use. Pain topography and characteristics are
different from pre-surgery and may relate to the pathophysiology of PHN. Skin
resection cannot be recommended as a treatment for PHN.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17451877 [PubMed - indexed for MEDLINE]

234: J Eur Acad Dermatol Venereol. 2007 May;21(5):712-3.

Ambilateral reactivation of herpes zoster V2 following cataract operation of both
eyes.

Korber A, Franckson T, Grabbe S, Dissemond J.

Publication Types: 
    Case Reports
    Letter

PMID: 17448008 [PubMed - indexed for MEDLINE]

235: J Eur Acad Dermatol Venereol. 2007 May;21(5):711-2.

Prurigo nodularis in healed herpes zoster scar: an isotopic response.

De D, Dogra S, Kanwar AJ.

Publication Types: 
    Case Reports
    Letter

PMID: 17448007 [PubMed - indexed for MEDLINE]

236: J Microbiol Immunol Infect. 2007 Apr;40(2):116-22.

Coinfection and clinical manifestations of tuberculosis in human immunodeficiency
virus-infected and -uninfected adults at a teaching hospital, northwest Ethiopia.

Kassu A, Mengistu G, Ayele B, Diro E, Mekonnen F, Ketema D, Moges F, Mesfin T,
Getachew A, Ergicho B, Elias D, Aseffa A, Wondmikun Y, Ota F.

Department of Microbiology and Parasitology, University of Gondar, Gondar,
Ethiopia. afeworkkassu@yahoo.com

BACKGROUND AND PURPOSE: The pattern of clinical presentations of tuberculosis
(TB) is reflected in the microbiological, radiological, and histological
characteristics of the disease. However, coinfection with human immunodeficiency 
virus (HIV) poses special diagnostic and therapeutic challenges. This study was
aimed at assessing the clinical manifestations of TB in patients with or without 
HIV coinfection in a hospital-based cross-sectional study in Gondar, Ethiopia.
METHODS: TB was diagnosed following standard clinical, bacteriological,
radiological, and histological procedures. HIV serostatus was checked by
enzyme-linked immunosorbent assay. RESULTS: This study included 257 TB patients, 
of whom 52.1% were coinfected with HIV. Pulmonary TB and extrapulmonary TB were
diagnosed in 64.2% and 35.8% of the patients, respectively. No significant
association was found between sputum smear positivity and HIV serostatus.
One-fifth of the patients reported hemoptysis. More than one-third had chest
pain, and >90% reported fever and weight loss. Night sweats and cough were
reported by 86% and 82.5%, respectively. Coarse crepitations were the most
frequent auscultatory finding (33.9%). Sputum smear positivity rate was 26.8%.
Cavitation was significantly associated with sputum smear positivity (odds ratio 
= 9.0, 95% confidence interval = 2.4-34.1). Wasting, cough of <or=5 months'
duration, crepitation, chronic diarrhea, and herpes zoster scar were
significantly associated with HIV-positive serology. CONCLUSION: Coinfection with
HIV was very high in patients with TB. The presence of herpes zoster scar,
chronic diarrhea, coarse crepitations, and cough of <or=5 months' duration may
assist in identifying TB patients with HIV infection.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17446959 [PubMed - indexed for MEDLINE]

237: Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004846.

Comment in:
    Evid Based Dent. 2007;8(3):85-6.

Topical lidocaine for the treatment of postherpetic neuralgia.

Khaliq W, Alam S, Puri N.

BACKGROUND: The cause of postherpetic neuralgia is damage to peripheral neurons, 
dorsal root ganglia, and the dorsal horn of the spinal cord, secondary to herpes 
zoster infection (shingles). In postherpetic neuralgia, peripheral neurons
discharge spontaneously and have lowered activation thresholds, and exhibit an
exaggerated response to stimuli. Topical lidocaine dampens peripheral nociceptor 
sensitisation and central nervous system hyperexcitability, and may benefit
patients with postherpetic neuralgia. OBJECTIVES: To examine the efficacy and
safety of topical lidocaine in the treatment of postherpetic neuralgia. SEARCH
STRATEGY: We searched the Cochrane Pain, Palliative and Supportive Care Group
Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, EMBASE, and LILACS, SIGLE for conference proceedings, Citation Index,
the reference lists of all eligible trials, key textbooks, and previous
systematic reviews. We also wrote to authors of all identified trials. SELECTION 
CRITERIA: Randomised or quasi-randomised trials comparing all topical
applications of lidocaine, including gels and patches in patients of all ages
with postherpetic neuralgia (pain persisting at the site of shingles at least one
month after the onset of the acute rash). DATA COLLECTION AND ANALYSIS: Two
review authors extracted data, and a third checked them. We obtained some missing
data from the US Food and Drugs Administration. MAIN RESULTS: Three trials
involving 182 topical lidocaine treated participants and 132 control participants
were included. Two trials gave data on pain relief, and the remaining study
provided data on secondary outcome measures. The largest trial published as an
abstract compared topical lidocaine patch to a placebo patch and accounted for
150 of the 314 patients (48%).A meta-analysis combining two of the three studies 
identified a significant difference between the topical lidocaine and control
groups for the primary outcome measure: a mean improvement in pain relief
according to a pain relief scale. Topical lidocaine relieved pain better than
placebo (P = 0.003).There was a statistical difference between the groups for the
secondary outcome measure of mean VAS score reduction (P = 0.03), but this was
only for a single small trial. There were a similar number of adverse skin
reactions in both treatment and placebo groups.The highest recorded blood
lidocaine concentration varied between 59 ng/ml and 431 ng/ml between trials. The
latter figure is high and the authors of the study suggest that the sample had
been contaminated during the assay procedure. AUTHORS' CONCLUSIONS: There is
insufficient evidence to recommend topical lidocaine as a first-line agent in the
treatment of postherpetic neuralgia with allodynia. Further research should be
undertaken on the efficacy of topical lidocaine for other chronic neuropathic
pain disorders, and also to compare different classes of drugs (e.g. topical
anaesthetics versus anti-epileptics).

Publication Types: 
    Meta-Analysis
    Review

PMID: 17443559 [PubMed - indexed for MEDLINE]

238: Clin Infect Dis. 2007 May 15;44(10):1280-8. Epub 2007 Apr 3.

Comment in:
    Clin Infect Dis. 2007 Dec 1;45(11):1527-9.

Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic
neuralgia in older adults.

Rothberg MB, Virapongse A, Smith KJ.

Division of General Medicine and Geriatrics, Department of Medicine, Baystate
Medical Center, Springfield, MA 01199, USA. Michael.Rothberg@bhs.org

BACKGROUND: A vaccine to prevent herpes zoster was recently approved by the
United States Food and Drug Administration. We sought to determine the
cost-effectiveness of this vaccine for different age groups. METHODS: We
constructed a cost-effectiveness model, based on the Shingles Prevention Study,
to compare varicella zoster vaccination with usual care for healthy adults aged
>60 years. Outcomes included cost in 2005 US dollars and quality-adjusted life
expectancy. Costs and natural history data were drawn from the published
literature; vaccine efficacy was assumed to persist for 10 years. RESULTS: For
the base case analysis, compared with usual care, vaccination increased
quality-adjusted life expectancy by 0.0007-0.0024 quality-adjusted life years per
person, depending on age at vaccination and sex. These increases came almost
exclusively as a result of prevention of acute pain associated with herpes zoster
and postherpetic neuralgia. Vaccination also increased costs by $94-$135 per
person, compared with no vaccination. The incremental cost-effectiveness ranged
from $44,000 per quality-adjusted life year saved for a 70-year-old woman to
$191,000 per quality-adjusted life year saved for an 80-year-old man. For the
sensitivity analysis, the decision was most sensitive to vaccine cost. At a cost 
of $46 per dose, vaccination cost <$50,000 per quality-adjusted life year saved
for all adults >60 years of age. Other variables related to the vaccine
(duration, efficacy, and adverse effects), postherpetic neuralgia (incidence,
duration, and utility), herpes zoster (incidence and severity), and the discount 
rate all affected the cost-effectiveness ratio by >20%. CONCLUSIONS: The
cost-effectiveness of the varicella zoster vaccine varies substantially with
patient age and often exceeds $100,000 per quality-adjusted life year saved. Age 
should be considered in vaccine recommendations.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17443464 [PubMed - indexed for MEDLINE]

239: Intern Med. 2007;46(8):535-6. Epub 2007 Apr 17.

Isolated trochlear nerve palsy in herpes zoster ophthalmicus.

Tsuda H, Ito T, Yoshioka M, Ishihara N, Sekine Y.

The Department of Internal Medicine, National Health Insurance Minamitama
Hospital, Tokyo. tsuda@minamitama.jp

Publication Types: 
    Case Reports

PMID: 17443053 [PubMed - indexed for MEDLINE]

240: Br J Dermatol. 2007 Jun;156(6):1369-71. Epub 2007 Apr 17.

Multiple dermatomal daughter lesions of postzoster granuloma.

Araki E, Kambe N, Takahashi K, Miyachi Y, Utani A.

Publication Types: 
    Case Reports
    Letter

PMID: 17441956 [PubMed - indexed for MEDLINE]

241: Br J Neurosurg. 2006 Dec;20(6):423-6.

Herpes zoster of the trigeminal nerve following microvascular decompression.

Simms HN, Dunn LT.

Department of Neurosurgery, Institute of Neurological Science, Southern General
Hospital, Glasgow, UK.

A patient developed herpes zoster of the maxillary division of the trigeminal
nerve after microvascular decompression. Varicella zoster virus lies dormant in
the Gasserian ganglion until reactivation and can cause herpes zoster
ophthalmicus. This can result in serious ocular complications including
blindness. Antiviral agents are effective if commenced promptly.

Publication Types: 
    Case Reports

PMID: 17439097 [PubMed - indexed for MEDLINE]

242: Rev Med Chir Soc Med Nat Iasi. 2006 Oct-Dec;110(4):852-5.

[Varicella-zoster infection--extreme clinical aspects]

[Article in Romanian]

Maniciuc C, Dorobat C, Hurmuzache M, Mihalache D, Luca V.

Facultatea de Medicina, Universitatea de Medicina "Gr.T. Popa", Iasi.

Infections with the varicella-zoster (VZ) virus are a constant of our everyday
practice. The aim of the present study is that of underlining unusual aspects of 
the infection with the VZ virus--primary infection in adults and herpes zoster in
children. If varicella, or chickenpox, has been traditionally considered a
childhood disease, nowadays, an increased number of adults are affected by
primary infections. On the contrary, more and more children present the secondary
form of the infection, which appears as herpes zoster, a disease usually
diagnosed in adults. MATERIAL AND METHODS: We studied the observation papers of
adult patients with varicella, hospitalized in our clinic during 2004-2005 and we
analyzed the herpes zoster manifestations in non-HIV children, diagnosed with the
disease during the same period of time. RESULTS: During 2004-2005, 34 adult
patients were diagnosed with varicella, while 10 children presented herpes
zoster. 16 of the adults with varicella were 25-34 years old. One of the children
with herpes zoster was less than one year old. All the adults with varicella were
treated with acyclovir; in 14 cases, the therapy was supplemented with
rifampicin. All the children with herpes zoster came from rural areas. The
pathology that determined the decrease of general immunity was represented by
neoplasia (3 cases), malnutrition and rickets (2 cases), associated infectious
pathologies--bronchopneumonia (3 cases). CONCLUSIONS: Varicella in adults has an 
increased incidence, which is underestimated, in our opinion. Its loud clinical
manifestations impose the therapy with acyclovir. Herpes zoster in children
reveals significant subsidiary pathologies and a depressed immune system that
impose special medical care and many days of hospitalization.

Publication Types: 
    English Abstract

PMID: 17438887 [PubMed - indexed for MEDLINE]

243: Medicine (Baltimore). 2007 Mar;86(2):78-92.

Cryptococcosis and idiopathic CD4 lymphocytopenia.

Zonios DI, Falloon J, Huang CY, Chaitt D, Bennett JE.

Clinical Mycology Section, Laboratory of Clinical Infectious Diseases, National
Institute of Allergy and Infectious Diseases, National Institutes of Health,
Bethesda, Maryland 20892, USA. zoniosd@niaid.nih.gov

We reviewed the cases of 11 patients with cryptococcosis and idiopathic CD4
lymphocytopenia (ICL) referred to our institution in the previous 12 years, as
well as 42 similar cases reported in the literature, to assess the
characteristics of the infection in this population. Cryptococcosis in 53
patients with ICL had features in common with cryptococcosis in previously normal
patients. ICL patients had a slight male predominance (1.2:1) and a median age of
presentation of 41 years (range, 4.5-85 yr). Initial cerebrospinal fluid findings
showed glucose below 40 mg/dL in 60% of the patients, a median pleocytosis of 59 
white blood cells/mm (range, 0-884), and protein of 156 mg/dL (range, 25-402
mg/dL). The median CD4 count at diagnosis of ICL and at the last available
measurement was 82 (range, 7-292) and 132 (range, 13-892) cells/mm, respectively,
for an average follow-up of 32 months in 46 patients. Unlike previously normal
patients with cryptococcosis, those with ICL had an excess incidence of
dermatomal zoster (7 episodes in 46 ICL cases). Pneumocystis pneumonia was rare
(1 case), casting doubt on the need for prophylaxis in patients with ICL. A
favorable outcome (cured or improved) may be more common in ICL patients than in 
previously normal patients with cryptococcal meningitis and no predisposing
factors. Identification of ICL in patients who were apparently normal before the 
onset of cryptococcosis appears to be useful because it predicts a favorable
outcome. Patients with cryptococcal infection and ICL have an increased
likelihood of developing dermatomal zoster. The long-term follow-up of these
patients offers some reassurance regarding favorable prognosis.

PMID: 17435588 [PubMed - indexed for MEDLINE]

244: Am J Ophthalmol. 2007 Jun;143(6):1003-1008. Epub 2007 Apr 16.

Multifocal posterior necrotizing retinitis.

Margolis R, Brasil OF, Lowder CY, Smith SD, Moshfeghi DM, Sears JE, Kaiser PK.

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

PURPOSE: To describe the clinical features of an acute, inflammatory, and
progressive retinal necrosis that affects primarily the posterior pole. DESIGN:
Retrospective, interventional case series. METHODS: Twenty-seven eyes of 24
patients diagnosed with and treated for acute retinal necrosis (ARN) were
categorized into two groups according to the predominant location of retinitis at
presentation: either in the peripheral retina or in the posterior pole. Clinical 
features, disease progression, visual outcomes, and complications of these two
groups were compared. RESULTS: Fifteen eyes demonstrated the known peripheral
retinitis pattern, and 12 eyes exhibited a pattern of retinitis that affected
mainly the posterior pole. Eyes with peripheral retinitis showed focal,
well-demarcated areas of retinal necrosis in the periphery with rapid
circumferential progression and rare involvement of the posterior pole. All eyes 
with posterior pole retinitis had multifocal deep lesions posterior to the vortex
veins at presentation, and half of these eyes had lesions in the macula. These
lesions progressed to patches of confluent retinitis in both the periphery and
the posterior pole. There was no significant difference between the two groups in
the incidence of anterior chamber and vitreous cells, vascular sheathing, retinal
hemorrhages, or optic disk edema. Patients with posterior retinitis involvement
seemed to have a worse visual outcome during the first two years after diagnosis.
The Cox proportional hazards model suggested a higher incidence of retinal
detachment in patients with posterior retinitis (P = .07). CONCLUSIONS: The
authors report a pattern of herpetic retinitis that affects predominantly the
posterior pole and may have a worse visual prognosis and a higher rate of retinal
detachment.

PMID: 17434436 [PubMed - indexed for MEDLINE]

245: Bioorg Med Chem Lett. 2007 Jun 15;17(12):3349-53. Epub 2007 Apr 5.

2-Aryl-2-hydroxyethylamine substituted 4-oxo-4,7-dihydrothieno[2,3-b]pyridines as
broad-spectrum inhibitors of human herpesvirus polymerases.

Schnute ME, Anderson DJ, Brideau RJ, Ciske FL, Collier SA, Cudahy MM, Eggen M,
Genin MJ, Hopkins TA, Judge TM, Kim EJ, Knechtel ML, Nair SK, Nieman JA, Oien NL,
Scott A, Tanis SP, Vaillancourt VA, Wathen MW, Wieber JL.

Global Research and Development, Pfizer Inc., 700 Chesterfield Parkway West, St. 
Louis, MO 63017, USA. mark.e.schnute@pfizer.com

A novel series of 2-aryl-2-hydroxyethylamine substituted
4-oxo-4,7-dihydrothieno[2,3-b]pyridine-5-carboxamides have been identified as
potent antivirals against human herpesviruses. These compounds demonstrate
broad-spectrum inhibition of the herpesvirus polymerases HCMV, HSV-1, EBV, and
VZV with high specificity compared to human DNA polymerases.

Publication Types: 
    Comparative Study

PMID: 17434304 [PubMed - indexed for MEDLINE]

246: Med Sci (Paris). 2007 Apr;23(4):423-7.

[Preventing papillomavirus infectious and herpes zoster: new vaccines]

[Article in French]

Silbermann B, Launay O.

CIC de vaccinologie Cochin-Pasteur, Pole de medecine interne, Hopital Cochin 27, 
rue du Faubourg Saint-Jacques, 75014 Paris, France.

Two new vaccines have been recently licensed : a quadrivalent vaccine against
Human papillomavirus infections (HPV) 6, 11, 16 and 18, recommended to children
from 9 years old and to young adults under the age of 26 years, and a vaccine
against herpes zoster for adults from 60 years old onwards. A bivalent vaccine
against HPV 16 and 18 will be shortly available. HPV vaccines are composed of the
L1 structural proteins of 2 or 4 HPV genotypes, produced by genetic engineering
and self-assembled. These inert vaccines are devoid of genetic materials and
mimic the viral particle (virus-like particle, VLP). They allow, as suggested by 
the 4.5 to 5 years follow-up, to prevent HPV infections and the onset of
pre-cancerous lesions associated with genotypes contained within the vaccine.
They represent a major overhang in the vaccinology field, and, as anti-hepatitis 
B vaccine, will probably be effective in cancer prevention. Their use must be
associated with the continued detection of cervix cancer by smears and also with 
the prevention of other sexually transmitted diseases. The herpes zoster vaccine 
is a living attenuated vaccine produced from the OKA/Merck strain already used in
the vaccine against varicella. Its safety is good among persons 50 years old and 
over and its efficiency on lowering herpes zoster incidence, on the burden of
illness and on post-herpetic neuralgia has been demonstrated in persons over 60
years old.

Publication Types: 
    English Abstract
    Review

PMID: 17433234 [PubMed - indexed for MEDLINE]

247: Cent Afr J Med. 2005 May-Jun;51(5-6):53-8.

Preterm delivery risk in relation to maternal HIV infection, history of malaria
and other infections among urban Zimbabwean women.

Noble A, Ning Y, Woelk GB, Mahomed K, Williams MA.

Department Of Epidemiology, University of Washington School of Public Health and 
Community Medicine, Seattle, USA.

OBJECTIVE: To examine preterm delivery risk in relation to maternal HIV
infection, malaria history, and other infections among Zimbabwean women. DESIGN: 
Hospital based, cross sectional study. SETTING: Harare Maternity Hospital,
Harare, Zimbabwe. SUBJECTS: A convenient sample of 500 pregnant women. MAIN
OUTCOME MEASURE: Preterm delivery. THE STUDY FACTORS: Maternal socio-demographic 
information, and infectious disease history (during the year before pregnancy).
METHOD: Between July 1998 and March 1999 data were collected for a cross
sectional study of pregnant women who delivered at the Harare Maternal Hospital. 
The association of maternal HIV infection, history of malaria, and other
infections with preterm delivery were determined using multivariate analysis.
RESULTS: Overall, 497 women were studied, 444 (89.3%) delivered at term and 53
women (10.7%) delivered preterm. Women who delivered preterm were less likely to 
be HIV seropositive compared with others (odds ratio [OR] = 0.75. 95% confidence 
interval (CI): 0.38 to 21.48). Preterm delivery was associated with having
tuberculosis infections in the year prior to the pregnancy (OR = 10.15, 95% CI:
1.15 to 89.87). Other infections associated with preterm delivery were malaria
(OR = 2.39, 95% CI: 1.07 to 5.31), chest infections (OR = 2.63, 95% CI: 0.76 to
9.17), and Herpes (shingles) infection (OR = 2.58, 95% CI: 0.56 to 11.85).
Overall, a positive history of any of the non-sexually transmitted infections (in
aggregate) was associated with a 3.20 fold increase risk for preterm delivery (OR
= 3.20. 95% CI: 1.59 to 6.43). Women with a history of infection and who did not 
use iron supplements during pregnancy, compared with women without such an
history and who used iron supplements, experienced the highest risk for preterm
delivery (OR = 8.34, 95% CI: 3.30 to 21.07). CONCLUSION: Maternal non-STD
infections, (i.e., tuberculosis, malaria, and chest infections) occurring in the 
year prior to pregnancy were associated with an increased risk of preterm
delivery. The association of non-sexually transmitted infections and preterm
delivery was particularly strong among women who did not use iron supplements
during pregnancy.

PMID: 17432432 [PubMed - indexed for MEDLINE]

248: Ear Nose Throat J. 2007 Mar;86(3):138, 140.

Ramsay Hunt syndrome, type I.

Gupta J, Hutchins T, Palacios E.

Department of Radiology, Tulane University Hospital and Clinics, New Orleans,
USA.

PMID: 17427772 [PubMed - indexed for MEDLINE]

249: Cont Lens Anterior Eye. 2007 Jul;30(3):204-6. Epub 2007 Apr 8.

Neurotrophic ulcer after extra-capsular cataract operation.

Yulek F, Cakmak HB, Cagil N, Orhan N, Altintas AG, Simsek S.

SB Ataturk Egitim ve Arastirma Hastanesi, Ankara, Turkey. fatmayulek@yahoo.com.tr

Although neurotrophic ulcers due to herpes zoster are seldom, there may be
challenging cases. Especially neurotrophic corneal ulcers after cataract
operations should arise the possibility of a previous herpes zoster attack and
the treatment plan should be prepared accordingly. This case highlights the
importance of thorough evaluation of cataract patients in order not to miss a
previous diagnosis of herpes.

Publication Types: 
    Case Reports

PMID: 17420151 [PubMed - indexed for MEDLINE]

250: Bone Marrow Transplant. 2007 Jun;39(11):661-5. Epub 2007 Apr 9.

Safety of vaccinating sibling donors with live-attenuated varicella zoster
vaccine before hematopoietic stem cell transplantation.

Leung AY, Chow HC, Kwok JS, Lui CK, Cheng VC, Yuen KY, Lie AK, Liang R.

Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong
Kong, China. ayhleung@hku.hk

Reactivation of varicella zoster virus (VZV), clinically manifested as herpes
zoster (HZ) is a common complication after hematopoietic stem cell
transplantation (HSCT). The optimum prophylaxis for this disease has not been
defined. In this study, we examined the effects of vaccinating donors with a
live-attenuated vaccine with particular reference to their immune responses and
the outcome of HSCT patients. Forty prospective HLA-matched sibling donors were
vaccinated before HSCT. There were humoral immune responses in both sero-positive
(P<0.01) and sero-negative (P=0.058) donors. Cellular immune response was assayed
in 26 donors. Significant correlation was observed between cellular immune
responses as enumerated by thymidine incorporation and interferon gamma secretion
(P<0.001) and the latter was used in subsequent analyses. Significant response
was observed in sero-negative (6/26) and a group of sero-positive (13/26) donors 
while 7/26 sero-positive donors showed no response. Thirty-four HSCT were
performed. These patients have a lower, albeit insignificant, risk of HZ compared
with historical controls and only 3/34 patients developed single dermatomal HZ at
6, 9 and 28 months after HSCT. No patients developed VZV-related mortality.
Vaccinating donors with live-attenuated VZV vaccine was safe, but whether it
confers a significant protection to the patients would require further study.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17417658 [PubMed - indexed for MEDLINE]

251: J Virol. 2007 Jun;81(12):6752-6. Epub 2007 Apr 4.

Productive varicella-zoster virus infection of cultured intact human ganglia.

Gowrishankar K, Slobedman B, Cunningham AL, Miranda-Saksena M, Boadle RA,
Abendroth A.

Center for Virus Research, Westmead Millenium Institute, and Department of
Infectious Diseases and Immunology, University of Sydney, Blackburn Building,
2006 NSW, Australia.

Varicella-zoster virus (VZV) is a species-specific herpesvirus which infects
sensory ganglia. We have developed a model of infection of human intact explant
dorsal root ganglia (DRG). Following exposure of DRG to VZV, viral antigens were 
detected in neurons and nonneuronal cells. Enveloped virions were visualized by
transmission electron microscopy in neurons and nonneuronal cells and within the 
extracellular space. Moreover, rather than remaining highly cell associated
during infection of cultured cells, such as fibroblasts, cell-free VZV was
released from infected DRG. This model enables VZV infection of ganglionic cells 
to be studied in the context of intact DRG.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17409155 [PubMed - indexed for MEDLINE]

252: J Dermatol. 2007 May;34(5):349-52.

Isolated double herpes zoster paresis involving the left facial nerve and the
right peroneal nerve following disseminated herpes zoster.

Takahama H, Tsukahara N, Hirayama M, Ito S, Sakuramoto C.

Department of Dermatology, Machida Municipal Hospital, Machida, Tokyo, Japan.
hdt2taka@rose.ocn.ne.jp

A 72-year-old Japanese male developed disseminated herpes zoster and could not
easily walk due to right drop foot and pain. He soon developed numbness and pain 
on the left side of his face, and noticed difficulty closing his left eye. The
left angle of his mouth dropped. The patient was diagnosed as having a double
mononeuropathy (a left facial nerve paresis and a right peroneal nerve paresis)
following disseminated herpes zoster. Given that the patient was elderly and had 
diabetes mellitus, the patient appeared to be an immunocompromised host. We also 
describe other rare complications of herpes zoster from the published work.

Publication Types: 
    Case Reports

PMID: 17408447 [PubMed - indexed for MEDLINE]

253: J Heart Lung Transplant. 2007 Apr;26(4):399-402.

Varicella infection after heart and lung transplantation: a single-center
experience.

Carby M, Jones A, Burke M, Hall A, Banner N.

Department of Transplantation, Harefield Hospital, Harefield, Middlesex, United
Kingdom. m.carby@rbht.nhs.uk

Disseminated varicella-zoster virus infection after organ transplantation in
adults is a rare but serious event causing significant morbidity and mortality.
We describe our 10-year experience of 13 cases in a single center, including risk
factors for infection, lack of protection from pre-existing anti-varicella-zoster
virus antibodies, and unusual modes of presentation, including disseminated
intravascular coagulation. We also report our preliminary observation of
resolution of infection without sequelae in 4 patients with severe disseminated
varicella-zoster virus infection who were treated with the combination of
intravenous acyclovir and polyspecific intravenous immunoglobulin.

PMID: 17403483 [PubMed - indexed for MEDLINE]

254: J Am Geriatr Soc. 2007 Apr;55(4):511-7.

Augmenting immune responses to varicella zoster virus in older adults: a
randomized, controlled trial of Tai Chi.

Irwin MR, Olmstead R, Oxman MN.

Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience,
University of California at Los Angeles, Los Angeles, California, USA.
mirwin1@ucla.edu

OBJECTIVES: To evaluate the effects of a behavioral intervention, Tai Chi, on
resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to
varicella zoster virus (VZV) and on health functioning in older adults. DESIGN: A
prospective, randomized, controlled trial with allocation to two arms (Tai Chi
and health education) for 25 weeks. After 16 weeks of intervention, subjects were
vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to
prevent varicella. SETTING: Two urban U.S. communities between 2001 and 2005.
PARTICIPANTS: A total of 112 healthy older adults aged 59 to 86. MEASUREMENTS:
The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes
were scores on the Medical Outcomes Study 36-item Short-Form Health Survey
(SF-36). RESULTS: The Tai Chi group showed higher levels of VZV-CMI than the
health education group (P<.05), with a significant rate of increase (P<.001) that
was nearly twice that found in the health education group. Tai Chi alone induced 
an increase in VZV-CMI that was comparable in magnitude with that induced by
varicella vaccine, and the two were additive; Tai Chi, together with vaccine,
produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi 
group also showed significant improvements in SF-36 scores for physical
functioning, bodily pain, vitality, and mental health (P<.05). CONCLUSION: Tai
Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the
varicella vaccine.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17397428 [PubMed - indexed for MEDLINE]

255: N Engl J Med. 2007 Mar 29;356(13):1338-43.

Comment in:
    N Engl J Med. 2007 Jul 5;357(1):88.    N Engl J Med. 2007 Jul 5;357(1):89.    N Engl J Med. 2007 Jul 5;357(1):89.    N Engl J Med. 2007 Jul 5;357(1):89.    N Engl J Med. 2007 Jul 5;357(1):89-90.

Varicella-zoster vaccine for the prevention of herpes zoster.

Kimberlin DW, Whitley RJ.

Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
35233, USA. dkimberlin@peds.uab.edu

Publication Types: 
    Review

PMID: 17392303 [PubMed - indexed for MEDLINE]

256: Am J Transplant. 2007 Apr;7(4):741-7.

Herpes simplex and varicella zoster viruses: forgotten but not gone.

Miller GG, Dummer JS.

Department of Medicine, Division of Infectious Diseases, Vanderbilt University
Medical Center, Nashville, Tennessee, USA. geraldine.miller@vanderbilt.edu

Herpesvirus infections are common complications of organ transplantation. The
most frequent herpesvirus infections are caused by cytomegalovirus (CMV), herpes 
simplex (HSV) and varicella zoster (VZV). Despite expansion of the therapeutic
armamentarium, HSV and VZV continue to cause morbidity and occasional mortality
in transplant recipients. Here we review the incidence and risk factors for HSV
and VZV disease, their clinical presentation, effects of newer immunosuppressive 
regimens and prophylaxis for HSV and VZV in solid organ transplant recipients.

Publication Types: 
    Review

PMID: 17391119 [PubMed - indexed for MEDLINE]

257: Eur J Neurol. 2007 Apr;14(4):e7-8.

Acquired prothrombotic state due to protein-losing enteropathy as a rare cause
for ischemic stroke?

Amtage F, Marouf W, Hetzel A, Schubert M.

Publication Types: 
    Case Reports
    Letter

PMID: 17388979 [PubMed - indexed for MEDLINE]

258: Pain Physician. 2007 Mar;10(2):301-4.

Seven zoster reactivations in an immune competent patient: how many is too many?

Rashid RM, Candido KD, Ibrahim S.

Loyola University Medical Center, Maywood, IL, USA. RashidRashid.MDPhD@yahoo.com

Herpes zoster virus (HZV) reactivation is commonly reported in elderly or immune 
compromised patients. However, certain presentations are rarely reported in
immune competent patients. Here we report a rare case of recalcitrant HZV
infection, including 7 reactivations over 3 years, in an immune competent
patient. Due to the pain experienced, this patient self-referred to our clinic,
and thus bypassed other specialties. As pain management specialists, it is
critical to be aware of such presentations, the clinical implications involved,
and management options to consider.

Publication Types: 
    Case Reports

PMID: 17387352 [PubMed - indexed for MEDLINE]

259: Br J Dermatol. 2007 May;156(5):1084-6. Epub 2007 Mar 23.

A case of herpes zoster in a child with congenital insensitivity to pain with
anhidrosis.

Ogata M, Misago N, Suzuki Y, Hirashima N, Inoue T, Yamasaki M, Narisawa Y.

Publication Types: 
    Case Reports
    Letter

PMID: 17381455 [PubMed - indexed for MEDLINE]

260: Tex Dent J. 2007 Jan;124(1):132, 136-8.

Oral and maxillofacial pathology case of the month. Herpes zoster (shingles).

Bouquot JE, Horn N, Wan SF.

Department of Diagnostic Sciences, University of Texas Dental Branch at Houston, 
USA.

Publication Types: 
    Case Reports

PMID: 17380914 [PubMed - indexed for MEDLINE]

261: Pain. 2007 Nov;132 Suppl 1:S52-9. Epub 2007 Mar 26.

Predicting postherpetic neuralgia in elderly primary care patients with herpes
zoster: prospective prognostic study.

Opstelten W, Zuithoff NP, van Essen GA, van Loon AM, van Wijck AJ, Kalkman CJ,
Verheij TJ, Moons KG.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, P.O. Box 85060, 3500 AB Utrecht, The Netherlands.
w.opstelten@umcutrecht.nl

Postherpetic neuralgia (PHN) is the most frequent complication of herpes zoster
(HZ) and difficult to treat. Timely identification of high-risk HZ-patients
enables physicians to focus on PHN prevention. To assess which simple to measure 
factors are independent predictors of PHN, and whether psychosocial and
serological/virological parameters have additional predictive value, a
prospective cohort study in primary care was conducted. We included 598 elderly
(>50 years) consecutive patients with acute HZ (rash <7 days) below sixth
cervical dermatome. At baseline demographic, clinical (e.g., duration and
severity of pain and rash), psychological (Pain Cognition List [PCL] and
Spielberger's Anxiety Inventory), serological (VZV-antibodies) and virological
(viremia presence) variables were measured. Blood tests were performed in a
random subset of 218 patients. Primary outcome was significant pain (VAS >30 on
0-100 scale) after three months. The final prediction model obtained from
multivariable logistic regression was (internally) validated using bootstrapping 
techniques, and adjusted for optimism. Forty-six (7.7%) patients developed PHN.
Independent predictors were age (odds ratio [OR]=1.08 per year), acute pain
severity (OR=1.02 per unit), presence of severe rash (OR=2.31), and rash duration
before consultation (OR=0.78 per day): area under
receiver-operating-characteristic curve [ROC area]=0.77 (95% CI: 0.71-0.82). Of
the five PCL scores, only factor V ('trust in healthcare') was an additional
predictor (OR=1.01 per unit), though it increased the ROC area with only 0.01 to 
0.78. The Spielberger's anxiety scores and serological and virological variables 
were no additional predictors. Thus, four simple variables can help physicians to
timely identify elderly HZ-patients at risk of PHN.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17379412 [PubMed - indexed for MEDLINE]

262: Mich Med. 2007 Jan-Feb;106(1):12-3.

ACIP recommends vaccine to prevent shingles.

[No authors listed]

PMID: 17375694 [PubMed - indexed for MEDLINE]

263: An Med Interna. 2007 Jan;24(1):31-4.

[Ramsay-Hunt syndrome]

[Article in Spanish]

Martinez Oviedo A, Lahoz Zamarro MT, Uroz del Hoyo JJ.

Medicina Familiar y Comunitaria, Hospital General Obispo Polanco, C/Jaca 4, 44002
Teruel. amoviedo25@yahoo.es

Ramsay-Hunt syndrome is a peripheral facial nerve palsy accompanied by an
erythematous vesicular rash on the ear or in the mouth; it is caused by varicella
zoster virus that affects the geniculate ganglion. The zoster oticus is the
second most common cause of atraumatic peripheral facial paralysis. We present a 
review of zoster oticus identified in our hospital among 2001-2005. We show
various atypical cases with multiple cranial nerve involvement; cerebellum and
spinal cord was affected in one patient. 3/10 cases were complicated with
pneumonia. So, we think that some grade of immunodeficiency may be present in
these cases. Treatment with acyclovir and prednisone has been successfully to
improve the outcome in the most of patients. Compared with Bell s palsy, patients
with zoster oticus often have more severe paralysis at onset and are less likely 
to recover completely.

Publication Types: 
    English Abstract

PMID: 17373867 [PubMed - indexed for MEDLINE]

264: J Drugs Dermatol. 2006 Nov-Dec;5(10):938-41.

Post-herpetic neuralgia: a review of advances in treatment and prevention.

Young L.

Department of Medicine, Dermatology Division, David Geffen School of Medicine at 
the University of California, Los Angeles, CA 90095, USA. lcyoung@mednet.ucla.edu

Post-herpetic neuralgia (PHN) is primarily a disease of the elderly and often
refractory to treatment. Randomized and controlled trials have yielded several
significant advances in the treatment and prevention of this disease. Treatment
advances include the lidocaine patch, opioid analgesics, nortriptyline,
amitriptyline, and gabapentin. However, no treatment regimen fully eliminates the
pain. Improvements in prevention include prompt recognition and treatment of
high-risk herpes zoster (HZ) patients with antiviral and analgesic therapies.
Even with these advances, PHN remains a debilitating and painful disease.
Vaccines offer the greatest promise of relief. The childhood vaccine against
varicella zoster virus offers long-lasting immunity, largely preventing HZ and
PHN. But most adults have already had varicella and are at risk for HZ and PHN as
they age. Therefore, a more potent vaccine against varicella has been developed
for use in adults. This vaccine offers a new and significant advance in the
prevention of HZ and its most noteworthy complication, PHN.

Publication Types: 
    Review

PMID: 17373141 [PubMed - indexed for MEDLINE]

265: Euro Surveill. 2007 Feb 20;12(2) [Epub ahead of print]

Surveillance of varicella and herpes zoster in Slovenia, 1996 - 2005.

Socan M, Blasko M.

Centre for Communicable Diseases, Institute of Public Health of Republic of
Slovenia, Ljubljana, Slovenia.

In Slovenia, varicella and herpes zoster infections are case-based mandatorily
notifiable diseases. We present surveillance data for a period of ten years (1996
- 2005). Incidences of varicella ranged from 456 to 777 per 100 000 population in
all age groups. As many as 75% of varicella cases reported were in pre-school
children, with children aged three and four years being most affected. The
incidence of varicella increased between October and January and was lowest in
August and September; the seasonal pattern matches patterns in the school
calendar. Herpes zoster was declared a reportable disease in 1995. In 2005, 1627 
cases were notified (81.3/100 000). Female cases outnumbered male. The highest
incidence of herpes zoster was noted in elderly individuals over 70 years of age.
Complications, such as zoster meningitis and meningoencephalitis, were rarely
reported (3.05/1 000 000).

PMID: 17370981 [PubMed - as supplied by publisher]

266: Zhongguo Zhen Jiu. 2007 Feb;27(2):123-5.

[Observation on therapeutic effect of surround needling plus surround moxibustion
on herpes zoster]

[Article in Chinese]

Zhang M, Qiu L, Zhang J.

Chengdu Hospital of Integrated Chinese and Western Medicine, Chengdu First
People's Hospital, Sichuan 610016, China. zm859@163.com

OBJECTIVE: To search for a better therapy for herpes zoster. METHODS: Seventy-two
cases of herpes zoster were randomly divided into a treatment group of 38 cases
treated with surround needling plus surround moxibustion (direct moxibustion at
the area of surround needling), and a control group of 34 cases treated with
surround needling the margin of the herpes zoster from "the head" to "the tail"
of the herpes zoster respectively. RESULTS: The 38 cases in the treatment group
were cured within 3 days with an effective rate of 97.4%, which was better than
85.3% in the control group (P<0.05), with the herpes stopping and scab time
shorten, and incidence of residual neuralgia reduced. CONCLUSION: Surround
needling plus surround moxibustion has obvious therapeutic effect on herpes
zoster.

Publication Types: 
    English Abstract
    Randomized Controlled Trial

PMID: 17370497 [PubMed - indexed for MEDLINE]

267: Ethiop Med J. 2006 Oct;44(4):401-4.

Ramsay Hunt syndrome.

T/Selasic H, Zenebe G.

Tikur Anbessa Specialized Hospital, Addis Ababa University P.O.Box 5657, Addis
Ababa, Ethiopia.

Ramsay Hunt Syndrome was described in a 58 years old woman from Addis Ababa. The 
woman presented with vesicular eruptions in the right ear which was followed by
weakness of the same side of face & otalgia. The objective of this case report is
to address herpes zoster & its complications with the treatment modalities & an
uncommon clinical entity, Ramsay hunt syndrome.

Publication Types: 
    Case Reports

PMID: 17370442 [PubMed - indexed for MEDLINE]

268: J Am Acad Dermatol. 2007 Apr;56(4):675-6.

New opportunities in preventative dermatology: how far should we go?

Zhang AY, Elmets CA, Camp WL, Elewski BE.

Skin Diseases Research Center and the Department of Dermatology, University of
Alabama at Birmingham, USA.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17367617 [PubMed - indexed for MEDLINE]

269: Int J Clin Pract. 2007 Jul;61(7):1223-9. Epub 2007 Mar 16.

The change in zoster-associated pain treated with oral valaciclovir in
immunocompetent patients with acute herpes zoster.

Kurokawa I, Murakawa K, Kumano K.

Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Mie, 
Japan. kuroichi@clin.medic.mie-u.ac.jp

We have analysed zoster-associated pain treated with valaciclovir (VCV) in
immunocompetent patients with acute herpes zoster over 6 months, and evaluated
the safety of VCV. We know of no reports that evaluate postherpetic neuralgia
(PHN) treated with VCV for 6 months. Predisposing factors that influence PHN were
age (over 60 years), clustered vesicles, severity of eruption, sleep disturbance,
and hypesthesia. Timing of the administration of VCV before or after the onset of
rash did not influence the incidence of PHN. No serious adverse reactions were
observed during the administration of VCV.

Publication Types: 
    Review

PMID: 17362479 [PubMed - indexed for MEDLINE]

270: Ned Tijdschr Tandheelkd. 2007 Feb;114(2):98-103.

[An unusual skin disorder after tooth extraction]

[Article in Dutch]

van Gemert JT, Koole R.

Tandheelkunde van het Universitair Medisch Centrum Utrecht.
J.T.M.vanGemert@umcutrecht.nl

A 72-year-old woman was referred to a department of oral and maxillofacial
surgery because of a unilateral skin eruption of the face after extraction of the
right first upper molar, a few days earlier. She had been diagnosed with chronic 
lymphocytic leukaemia some years before. It appeared to be herpes zoster
or'shingles'from the second branch of the trigeminal nerve. Treatment included
hospital admission with intravenous antiviral therapy and analgetics. Herpes
zoster of the face is a severe infection and requires early treatment. Post
herpetic neuralgia is a serious complication of herpes zoster and may adversely
affect the quality of life.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17361787 [PubMed - indexed for MEDLINE]

271: Can J Ophthalmol. 2007 Feb;42(1):152-3.

Herpes zoster ophthalmicus and sixth nerve palsy in a pediatric patient.

Liao W, Chu G, Hutnik CM.

Publication Types: 
    Case Reports
    Letter

PMID: 17361269 [PubMed - indexed for MEDLINE]

272: Public Health Rep. 2007 Mar-Apr;122(2):155-9.

Chickenpox exposure and herpes zoster disease incidence in older adults in the
U.S.

Chaves SS, Santibanez TA, Gargiullo P, Guris D.

Viral Diseases Division, Centers for Disease Control and Prevention,1600 Clifton 
Rd., NE; MS-A-47, Atlanta, GA, 30333, USA. schaves@cdc.gov

OBJECTIVES: Exposure to varicella zoster virus through close contact with people 
with chickenpox was suggested to boost specific immunity, reducing the risk of
herpes zoster (HZ). Since the introduction of the varicella immunization program 
in the US in 1995, varicella morbidity has decreased substantially. This article 
examines incidence and risk factors associated with self-reported HZ disease and 
whether exposure to chickenpox within the previous decade reduces the risk of
shingles in this age group. METHODS: In 2004, a national random-digit dial
telephone survey was used to obtain information on self-reported HZ disease,
demographic characteristics, and exposure to children with chickenpox in the past
decade. National estimates of the incidence of shingles disease were calculated. 
RESULTS: Incidence rate of self-reported HZ was 19 per 1,000 population per year.
White individuals were 3.5 times more likely to report shingles than Hispanic
individuals (p<0.01). Previous exposure to chickenpox did not protect against HZ 
disease in this population. Seven percent of adults > or =65 years of age
reported exposure to children with chickenpox in the past decade. CONCLUSIONS:
Incidence of HZ among individuals > or =65 years of age in the U.S. may be higher
than previously described in the literature, with whites being at higher risk for
the disease. Currently, the potential contribution of exposure to chickenpox as a
mechanism for maintaining cell-mediated immunity against HZ may be limited to a
small percentage of the population. Vaccination against HZ may represent the best
means of decreasing this disease burden.

PMID: 17357357 [PubMed - indexed for MEDLINE]

273: Eur J Hum Genet. 2007 Jun;15(6):672-8. Epub 2007 Mar 14.

Does apolipoprotein E determine outcome of infection by varicella zoster virus
and by Epstein Barr virus?

Wozniak MA, Shipley SJ, Dobson CB, Parker SP, Scott FT, Leedham-Green M, Breuer
J, Itzhaki RF.

Faculty of Life Sciences, The University of Manchester, Manchester, UK.

Over 90% of the population are infected with varicella zoster virus (VZV) but
only some develop shingles - caused when the virus reactivates from latency, and 
only some shingles patients develop post-herpetic neuralgia (PHN), defined as
pain continuing for more than about 4 months. Epstein Barr virus (EBV) similarly 
infects over 90% of the population; some of those infected during teenage or
young adult years develop infectious mononucleosis (IM). The reason for these
disparities between numbers infected and numbers affected by illness is unknown, 
but presumably reflects host factor(s). Our previous results showed that
apolipoprotein E (APOE) genotype determines susceptibility to, or outcome of,
infection in the case of several diseases of known infectious cause. Therefore,
we investigated APOE genotypes of shingles, PHN, and IM patients. Our rationale
for the previous studies and for investigating VZV was that these micro-organisms
use for cell binding and entry the same sites in the cell surface as does the
protein apoE, and that consequently, competition with apoE could affect the
pathogen's extent of entry and hence extent of the damage caused. The APOE
genotypes of shingles and PHN sufferers, and of IM sufferers were determined
using restriction fragment length polymorphism. In females, epsilon4 homozygosity
confers a risk of shingles and also of IM, and the APOE-epsilon4 allele is
protective against PHN whereas APOE-epsilon3 allele is a risk. Our results
showing that a host genetic factor influences the development of shingles and PHN
in females have clinical significance: they could lead to identification of those
(female) patients at greater risk of PHN, thus enabling these people to be
targeted for treatment with the most effective drugs.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17356546 [PubMed - indexed for MEDLINE]

274: Rev Med Suisse. 2007 Jan 10;3(93):14-7.

[Geriatrics]

[Article in French]

Bula C, Gold G.

Service de geriatrie et readaptation geriatrique, Centre universitaire de
traitements et de readaptation (CUTR) Sylvana, Departement de medecine, CHUV CUTR
Sylvana, 1066 Epalinges. christophe.bula@chuv.ch

A new vaccine reduces the incidence and severity of zoster and its complications 
in older persons. A cost-effectiveness analysis highlights the implication of
CDC's recent recommendation to vaccinate all persons aged 60 years and over. A
meta-analysis confirms that the chronic use of sedatives in older persons
provides modest benefits and important risks. Unfortunately, melatonin does not
seem to be a useful alternative. A systematic review of interventions to prevent 
pressure ulcers provides scientific support to measures empirically used in most 
institutions. Finally, a randomized controlled trial questions the clinical
benefit of atypical neuroleptics in Alzheimer's disease and a comprehensive
review of pharmacological trials in mild cognitive impairment reports no benefit 
of any of the tested drugs on conversion rate to Alzheimer's disease.

Publication Types: 
    English Abstract

PMID: 17354654 [PubMed - indexed for MEDLINE]

275: Harefuah. 2007 Feb;146(2):89-91, 167.

[Varicella zoster virus infection involving the maxillary branch of the
trigeminal nerve]

[Article in Hebrew]

Warman M, Halperin D.

Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center,
Rehovot. meirwa@clalit.org.il

Herpes zoster is an infection caused by reactivation of the latent varicella
virus in the sensory ganglia. The mechanisms responsible for Varicella zoster
virus (VZV) reactivation are poorly understood. Yet, it is believed that
decreased cellular immunity can be a trigger for it's reactivation. The
occurrence of herpes zoster in young people may point to an underlying
immunodeficiency. Therefore, the possibility of concomitant HIV infection must be
eliminated. Herpes zoster manifests as a vesicular rash along a sensory
dermatome, usually preceded by pain or paresthesia of the involved cutaneous
area. The most commonly affected dermatomes are those of the thorax and abdomen, 
followed by the cranial nerves, especially the trigeminal nerve. The maxillary
nerve is the least frequently affected branch of the trigeminal nerve and only
rarely causes ocular injury. This is a case history of a young patient infected
with VZV involving the maxillary branch of the trigeminal nerve, complicated by
secondary bacterial infection of the ipsilateral hemiface. The literature
regarding the epidemiology, pathogenesis, complications and the proper treatment 
of herpes zoster is reviewed with an emphasis on the involvement of cranial
nerves.

Publication Types: 
    English Abstract

PMID: 17352273 [PubMed - indexed for MEDLINE]

276: Nihon Kokyuki Gakkai Zasshi. 2007 Feb;45(2):166-9.

[A case of diaphragmatic paralysis caused by herpes zoster after anticancer
chemotherapy]

[Article in Japanese]

Morinaga R, Matsunaga N, Iwata A, Kishi K, Tokimatsu I, Nagai H, Kadota J.

Second Department of Internal Medicine, Oita University Faculty of Medicine.

A 61-year-old woman who had been followed up after resection of lung cancer
(adenosquamous cell carcinoma), was admitted to our hospital because of
recurrence. She received systemic anticancer chemotherapy and the chief adverse
event was leukopenia (Grade 3). Nineteen days after initiating chemotherapy, she 
suffered painful vesicular eruption on the right upper limb and the right upper
hemithorax which was diagnosed as herpes zoster. After treatment with anti-viral 
drugs the vesicular eruption disappeared, but chest X-ray film revealed a right
diaphragmatic relaxation. Although herpes zoster virus usually affects sensory
nerves and causes painful vesicular eruption, it can also damage motor nerves.
Herpes zoster virus almost affects cranial nerves, but it should be considered as
the cause of diaphragmatic paralysis in this case.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17352174 [PubMed - indexed for MEDLINE]

277: J Neurol. 2007 Mar;254(3):400-1. Epub 2007 Mar 7.

Posterior horn varicella-zoster virus myelitis.

Toledano R, Lopez-Sendon J, Gilo F, Riva E, Martinez-San Millan J, Masjuan J.

Publication Types: 
    Case Reports
    Letter

PMID: 17345034 [PubMed - indexed for MEDLINE]

278: Mov Disord. 2007 May 15;22(7):1024-6.

PRKCG mutation (SCA-14) causing a Ramsay Hunt phenotype.

Visser JE, Bloem BR, van de Warrenburg BP.

Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen,
The Netherlands. j.visser@neuro.umcn.nl

Progressive myoclonic ataxia, also referred to as Ramsay Hunt syndrome, is
characterized by a combination of myoclonus and cerebellar ataxia, infrequently
accompanied by tonic-clonic seizures. Its differential diagnosis overlaps with
progressive myoclonic epilepsy, a syndrome with myoclonus, tonic-clonic seizures,
progressive ataxia and dementia. In patients with progressive myoclonic epilepsy,
specific diseases can frequently be recognized, but the diagnostic yield in
progressive myoclonic ataxia is much lower. We describe a patient who presented
with multifocal myoclonus in his thirties and who later developed cerebellar
ataxia and focal dystonia. His father was similarly affected. Genetic studies
revealed a mutation in the protein kinase C gamma (PRKCG) gene, known to cause
spinocerebellar ataxia type 14 (SCA-14). This case illustrates that both
myoclonus and dystonia are part of the clinical spectrum in SCA-14 and that
myoclonus can even be the presenting symptom. We suggest that SCA-14 should be
considered in the differential diagnosis of progressive myoclonic ataxia. (c)
2007 Movement Disorder Society.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 17343273 [PubMed - indexed for MEDLINE]

279: Rev Med Liege. 2007 Jan;62(1):44-7.

[How I prevent...herpes zoster by vaccination]

[Article in French]

Nikkels AF, Pierard GE.

Service de Dermatopathologie, CHU Sart Tilman, Liege, Belgique.

Herpes zoster (HZ) results from reactivation of the varicella-zoster virus (VZV),
which remains latent in the dorsal root ganglia after varicella. HZ predominantly
affects people over 50 years of age without gender distinction, and its incidence
increases with age. The most feared complication of HZ is the zoster-associated
pains (ZAP), which encompasses the prodromal, concomitant and post-zoster
persistent pains. The latter neuralgias are particularly invalidating and
notoriously difficult, or even impossible to abate with current therapies. Until 
now, the best ZAP prevention was achieved by antiviral treatment given during the
earliest phase of the eruption. This treatment certainly reduces the duration and
intensity of ZAP, but exerts little influence on post-zoster persistent pains. A 
vaccination boosting the specific anti-VZV immunity in order to decrease the HZ
incidence and post-zoster pains appears promising. A recent study performed on
38.546 immunocompetent patients aged over 60 years assessed the efficacy of a
single injection of an anti-zoster vaccine (Zostavax). The incidence of HZ and
post-zoster pain was decreased by 50% and 66%, respectively. Vaccination could be
considered as a valuable option to alleviate the feared complications of HZ.

Publication Types: 
    English Abstract
    Review

PMID: 17343129 [PubMed - indexed for MEDLINE]

280: J Clin Virol. 2007 Apr;38(4):275-9. Epub 2007 Mar 6.

Comment in:
    J Clin Virol. 2007 Jul;39(3):238-9.

Clinical and psychosocial correlates of acute pain in herpes zoster.

Volpi A, Gatti A, Serafini G, Costa B, Suligoi B, Pica F, Marsella LT, Sabato E, 
Sabato AF.

Department of Public Health, University of Rome Tor Vergata, Italy.
volpi@med.uniroma2.it <volpi@med.uniroma2.it>

BACKGROUND: Acute and persistent pain are the most significant clinical
manifestations of herpes zoster (HZ), but the characteristics of acute pain in HZ
patients have been inadequately investigated. OBJECTIVES: To correlate the
severity of acute pain with clinical, demographic and psychosocial
characteristics of HZ patients. STUDY DESIGN: Five hundred thirty-three patients 
with acute HZ were recruited by 119 dermatologists who collected medical and
demographic data at diagnosis, provided counselling and therapy where appropriate
and asked the patients to complete the Short Italian Questionnaire designed for
comprehensive evaluation of HZ patients. RESULTS: In a univariate analysis,
greater acute pain severity was significantly associated with female gender,
number of dermatomes affected, presence of prodromal pain, abnormal sensations
(dysesthesia), education level, anxiety and depression. Quality of life, even if 
greatly reduced, did not correlate with the intensity of pain. In a multivariate 
model, the intensity of pain was independently associated with the extent of rash
(p=0.042), presence of prodromal pain (p=0.005), dysesthesia, education level
(p=0.040), and depression (p<0.001), but not with gender, anxiety or quality of
life. CONCLUSIONS: This study suggests that in patients with acute HZ the
severity of the disease and depression at presentation are the main correlates of
pain intensity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17339131 [PubMed - indexed for MEDLINE]

281: Eur J Pediatr. 2008 Jan;167(1):47-55. Epub 2007 Mar 3.

Varicella vaccination in Europe: are we ready for a universal childhood
programme?

Sengupta N, Booy R, Schmitt HJ, Peltola H, Van-Damme P, Schumacher RF, Campins M,
Rodrigo C, Heikkinen T, Seward J, Jumaan A, Finn A, Olcen P, Thiry N,
Weil-Olivier C, Breuer J.

Centre for Child Health, Royal London Hospital, 38 New Road, Whitechapel, London,
E1 2AX, UK.

Safe and effective vaccines against varicella zoster virus (VZV), the
aetiological agent of varicella and shingles, have been available in Europe for
the last 5-10 years. The USA has had a universal childhood vaccination policy
since 1995 and this has resulted in a dramatic decrease in the incidence,
morbidity and mortality related to varicella. The economic and medical burden of 
VZV has led to discussions regarding both the desirability and feasability of a
similar routine immunisation policy for all European children. This article
examines the epidemiology of varicella in Europe and how the data emerging from
the USA can be used to achieve adequate prevention of the disease. It looks into 
the current evidence of the health economic evaluation of universal varicella
vaccination and explores the concerns surrounding such a policy, including the
postulated impact on the incidence of zoster. In conclusion, the Society of
Independent European Vaccination Experts (SIEVE) recommends that the immunisation
of susceptible adolescents needs to be urgently implemented, in addition to the
current recommendations targeting high-risk patients, their close contacts with a
negative history of varicella and seronegative health-care workers. A universal
policy, optimally incorporating a two-dose schedule, will be needed to finally
reduce the burden of disease of varicella from a societal point of view. The
SIEVE recommends the implementation of such a policy as soon as financially and
practically possible.

PMID: 17334784 [PubMed - in process]

282: FDA Consum. 2006 Sep-Oct;40(5):38-9.

Vaccine approved for shingles in older people.

[No authors listed]

A new vaccine called Zostavax is available to reduce the risk of shingles (herpes
zoster) in people ages 60 and older.

PMID: 17326312 [PubMed - indexed for MEDLINE]

283: Neurologia. 2007 Jan-Feb;22(1):46.

[Trigeminal herpes zoster. Pons hypersignal in magnetic resonance imaging]

[Article in Spanish]

Perez Navarro JM, Escamilla Sevilla F, Pastor Rull J.

Servicio de Neurologia, Hospital Universitario Virgen de las Nieves, Granada.
majosepn@fundacionhvn.org

Publication Types: 
    Case Reports

PMID: 17315102 [PubMed - indexed for MEDLINE]

284: J Med Virol. 2007 Apr;79(4):413-25.

Infection and direct injury in human hepatocyte explants and a hepatoblastoma
cell line due to hepatiticomimetic (non-hepatitis) viruses.

Phromjai J, Aiba N, Suzuki M, Sato H, Takahara T, Kondo S, Shiraki K.

Department of Virology, University of Toyama, Sugitani, Toyama, Japan.

Hepatitis is caused by hepatitis viruses, but hepatitis or hepatocellular enzyme 
abnormalities is sometimes associated with infection by the hepatiticomimetic
viruses. The direct and indirect effects of infection with hepatiticomimetic
viruses were examined in two human hepatocyte systems. Poliovirus, adenovirus,
and herpes simplex virus (HSV) induced cytopathology in Hep G2 cells. Measles
virus caused no change in hepatocytes. Poliovirus infection did not affect
cellular protein synthesis, and the peak of hepatocellular enzyme release
coincided with the peak of virus release. The increase in adenovirus protein
synthesis correlated with the decrease of transferrin synthesis, and enzyme
release was not prominent. HSV induced viral protein synthesis with enhanced
processing and inhibition of synthesis of alpha1-antitrypsin. The peak of enzyme 
release was later than the peak of virus release. In primary hepatocytes,
poliovirus, adenovirus, and induced extensive cytopathology and enzyme release,
and VZV caused cytopathology and significant but minute enzyme release. The ratio
of lactate dehydrogenase to aspartate aminotransferase release was larger in
poliovirus infection in both hepatocytes than in HSV or VZV infection. Although
poliovirus and adenovirus are released by cytolysis and HSV and VZV are secreted 
by exocytosis of cytoplasmic vacuoles, enzyme release was independent of the type
of virus release. Adenovirus showed strong cytotoxicity but did not modify the
membrane nor cause enzyme release. Enzyme release was associated with
modification of the surface membrane due to apoptosis with poliovirus and
necrosis with HSV. Consequently hepatocellular injury by viral infection did not 
reflect the amount or pattern of hepatocellular enzyme release. (c) 2007
Wiley-Liss, Inc.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17311334 [PubMed - indexed for MEDLINE]

285: J Eur Acad Dermatol Venereol. 2007 Mar;21(3):431-2.

Occurrence of acne comedones over healed linear scar of herpes zoster: a
neurogenic perception.

Sardana K, Relhan V, Sehgal VN, Garg VK, Kochhar AM.

Publication Types: 
    Case Reports
    Letter

PMID: 17309494 [PubMed - indexed for MEDLINE]

286: Rev Neurol (Paris). 2007 Jan;163(1):89-92.

[VZV-related myelitis: a pathophysiological hypothesis]

[Article in French]

Outteryck O, Deramecourt V, Bombois S, Mackowiak-Cordoliani MA, Pasquier F.

Clinique Neurologique, Hopital Roger Salengro, CHRU de Lille, 59037 Lille Cedex.

INTRODUCTION: Complications of VZV infection in the central nervous system are
multiple. VZV-related myelitis is an uncommon complication of herpes zoster.
OBSERVATION: We report the case of a 55-year old man with intercostal herpes
zoster who presented a subacute medullar syndrome. MRI demonstrated an extended
cervico-thoracic medullar hyperintensity on the T2-weighted images. Cerebrospinal
fluid (CSF) analysis showed 100 leukocytes/mm3, 0.94 g/L protein, negative VZV
PCR, elevated rate of anti-VZV IgG and no oligoclonal bands. Clinical, biological
and radiological presentations were compatible with the diagnosis of VZV-related 
myelitis with three potential pathophysiological mechanisms: infectious, immune
post-infectious, vascular. The course was partially favorable after a 3-day
regimen of corticosteroid and 3 weeks of acyclovir infusions. DISCUSSION:
Parainfectious myelitis is often the consequence of a viral infection with a
post-infectious pathogenesis. Most often, the clinical outcome is good. In this
case report, we highlight the VZV vascular tropism and its more severe outcome.
CONCLUSION: VZV-related myelitis should be diagnosed early. The combination of
aciclovir and corticoids infusions seems to be beneficial.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17304177 [PubMed - indexed for MEDLINE]

287: Iran J Allergy Asthma Immunol. 2005 Jun;4(2):95-8.

The Seroepidemiology of Varicella Zoster Virus (VZV) in Different Age Groups in
Tehran, Iran.

Sharifi Z, Emadi Ghanjin S.

Research Center of Iranian Blood Transfusion Organization (IBTO), Tehran, Iran.
sharifiz@yahoo.com.

Varicella zoster virus (VZV), the causative agent of chicken pox and shingles,
can cause severe systemic infections of the CNS and the respiratory tract in
immunocompetent individuals as well as in immunocompromized patients.The aim of
this cross-sectional study was to assess the prevalence of antibody Varicella
zoster virus in different age groups.The enzyme linked immunosorbent assay
(ELISA) method was used to assess the presence of anti -VZV antibody.A total of
635 serum samples were collected. Age specific prevalence of IgG antibody to VZV 
showed a progressive increase with age in both males and females. The overall
seroprevalence rate was 83.6%. Prevalence of antibodies was 59.7% in the age
group of less than 10 years, 60.4 % in 10-14 years, 87.5 % in 15-19 years, 88 %
in 20-24 years, 89.4 % in 25-29 years and 87.9 % in 30-39 years.The data show
that children should be considered as a target group for prevention programs
against VZV infection.

PMID: 17301429 [PubMed - in process]

288: Pediatr Dermatol. 2007 Jan-Feb;24(1):34-7.

Ramsay Hunt syndrome in a 3-month-old infant.

Balatsouras DG, Rallis E, Homsioglou E, Fiska A, Korres SG.

ENT Department, Tzanion General Hospital, Piraeus, Greece. balats@panafonet.gr

Ramsay Hunt syndrome is a disorder characterized by herpetic eruptions on the
auricle, facial paralysis, and vestibulocochlear dysfunction, and is attributed
to varicella zoster virus infection in the geniculate ganglion. Although it is a 
common cause of acute peripheral facial paralysis, children are not usually
affected. We describe Ramsay Hunt syndrome in a 3-month-old infant who was
referred because of a 2-day-old appearance of herpetic blisters on the right
auricle and along the distribution of the right facial nerve. His mother had been
infected with chickenpox during the second trimester of pregnancy. The infant
presented with right facial palsy and was anxious, but had no fever. Otoscopy
revealed herpetic eruptions in the right ear canal. Otoacoustic emissions were
absent in the right ear and auditory brainstem responses confirmed moderate
sensorineural hearing loss. Appropriate treatment resulted in slight improvement 
after the first week and complete recovery within 4 months. Infection with
varicella zoster virus was proved by a significant increase in the serum
anti-varicella zoster virus antibody titer during the convalescent phase of the
disease.

Publication Types: 
    Case Reports

PMID: 17300646 [PubMed - indexed for MEDLINE]

289: Hum Vaccin. 2007 Mar-Apr;3(2):64-8. Epub 2007 Mar 23.

Vaccination to prevent herpes zoster and postherpetic neuralgia.

Oxman MN.

University of California San Diego, VA San Diego Healthcare System, San Diego,
California, USA. mnoxman@ucsd.edu

Publication Types: 
    Review

PMID: 17299270 [PubMed - indexed for MEDLINE]

290: J Environ Sci (China). 2006;18(6):1193-8.

Investigation on Fe, Mn, Zn, Cu, Pb and Cd fractions in the natural surface
coating samples and surficial sediments in the Songhua River, China.

Guo SH, Wang XL, Li Y, Chen JJ, Yang JC.

Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang 110016,
China. shuhaiguo@iae.ac.cn

Natural surface coating samples (NSCSs) from the surface of shingles and
surficial sediments (SSs) in the Songhua River, China were employed to
investigate the relationship between NSCSs and SSs in fractions of heavy metals
(Fe, Mn, Zn, Cu, Pb, and Cd) using the modified sequential extraction procedure
(MSEP). The results show that the differences between NSCSs and SSs in Fe
fractions were insignificant and Fe was dominantly present as residual phase
(76.22% for NSCSs and 80.88% for SSs) and Fe-oxides phase (20.33% for NSCSs and
16.15% for SSs). Significant variation of Mn distribution patterns between NSCSs 
and SSs was observed with Mn in NSCSs mainly present in Mn-oxides phase (48.27%) 
and that in SSs present as residual phase (45.44%). Zn, Cu, Pb and Cd were found 
dominantly in residual fractions (>48%), and next in solid oxides/hydroxides for 
Zn, Pb and Cd and in easily oxidizable solids/compounds form for Cu,
respectively. The heavy metal distribution patterns implied that Fe/Mn oxides
both in NSCSs and SSs were more important sinks for binding and adsorption of Zn,
Pb and Cd than organic matter (OM), and inversely, higher affinity of Cu to OM
than Fe/Mn oxides in NSCSs and SSs was obtained. Meanwhile, it was found that the
distributions of heavy metals in NSCSs and SSs were similar to each other and the
pseudo-total concentrations of Zn, Cu, Pb and Cd in NSCSs were greater than those
in SSs, highlighting the more importance for NSCSs than SSs in controlling
behaviours of heavy metals in aquatic environments.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17294964 [PubMed - indexed for MEDLINE]

291: J Hum Lact. 2007 Feb;23(1):70-1.

Herpes zoster in the T4 dermatome: a possible cause of breastfeeding strike.

Mathers LJ, Mathers RA, Brotherton DR.

University of Pittsburgh School of Medicine, Waukesha Family Practice Residency
Program, Pittsburgh, PA, USA.

The authors report a case of breastfeeding strike temporally related to the onset
of a herpes zoster prodrome involving the left breast.

Publication Types: 
    Case Reports

PMID: 17293553 [PubMed - indexed for MEDLINE]

292: Epidemiol Infect. 2007 Aug;135(6):908-13. Epub 2007 Feb 12.

Secular trends in the epidemiology of shingles in Alberta.

Russell ML, Schopflocher DP, Svenson L, Virani SN.

Department of Community Health Sciences, University of Calgary, Calgary, Canada. 
mlrussel@ucalgary.ca

Varicella vaccine was licensed in Canada in 1998, and a publicly funded
vaccination programme introduced in the province of Alberta in 2001. In theory
the vaccination programme might increase the burden of disease from shingles,
making it important to develop baseline data against which future comparisons can
be made. The study's aim was to describe the epidemiology of non-fatal cases of
shingles for which publicly funded health services were utilized for the period
1986-2002. Shingles cases were identified from the records of Alberta's
universal, publicly funded health-care insurance system for 1986-2002. The
earliest dated health service utilizations for ICD-9-CM codes of 053 or ICD-10-CA
codes of B02 were classified as incident. Diagnostic codes at least 180 days
after the first were classified as recurrent episodes. Denominators for rates
were estimated using mid-year population estimates from the Alberta Health Care
Insurance Plan Registry. Annual age- and sex-specific rates were estimated. We
explored the pattern of rates for sex, age and year effects and their
interactions. Shingles rates increased between 1986 and 2002. There was a sex
effect and evidence of an age-sex interaction. Females had higher rates than
males at every age; however, the difference between females and males was
greatest for the 50-54 years age group and declined for older age groups. The
increased rate of shingles in Alberta began before varicella vaccine was licensed
or publicly funded in Alberta, and thus cannot be attributed to vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17291380 [PubMed - indexed for MEDLINE]

293: Dermatol Nurs. 2006 Dec;18(6):529.

More advances for dermatology patients.

Hill MJ.

Publication Types: 
    Editorial

PMID: 17286153 [PubMed - indexed for MEDLINE]

294: Am J Dermatopathol. 2007 Feb;29(1):109-11.

Comment on:
    Am J Dermatopathol. 2006 Apr;28(2):181-6.

The many faces of alpha-herpesviridae infections.

Nikkels AF, Pierard GE.

Publication Types: 
    Comment
    Letter

PMID: 17284977 [PubMed - indexed for MEDLINE]

295: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006 Nov;41(11):821-4.

[Bilateral facial nerve paralysis-diagnosis and treatment]

[Article in Chinese]

Wang H, Gao ZQ, Li YL, Liu W, Quan SM.

Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100730,
China.

OBJECTIVE: To observe the ways of diagnosis and treatment of bilateral facial
nerve palsy. METHODS: Seven cases of bilateral facial nerve paralysis in 1996 -
2003 were retrospectively reviewed, and then the ways of diagnosis and therapies 
of these cases were analyzed. There were 6 patients with doubtless diagnosis.
They were diagnosed as acute leukaemia, Vogt-Koyanagi-Harada disease (VKH),
Machado-Jesoph disease, bilateral mandible fractures, Guillain-Barre syndrome,
and Bell's palsy. The last one was diagnosed as Herpes zoster virus infection or 
Lyme disease. In all these cases, there were 4 of 5 positive cerebrospinal fluids
test, 1 of 6 positive lyme antibody test, 2 of 5 positive images test, 7 of 7 EMG
and Br test showed that the paralysis was peripheral palsy. All the 7 cases were 
treated with steroid and vitamin. RESULTS: House-Brackmann I was defined as
complete recovery, after up to 2 months follow up, there were four cases got
completely recovery while 2 cases incomplete recovery, and 1 case was not reacted
to the therapy. CONCLUSIONS: Bilateral facial nerve paralysis was rare, and it
was difficult to diagnosis and differentiation, while diagnostic mistakes would
be serious. More attention should be paid to it in clinic.

Publication Types: 
    English Abstract

PMID: 17283534 [PubMed - in process]

296: J Clin Virol. 2007 Mar;38(3):254-9. Epub 2007 Feb 5.

Progressive outer retinal necrosis in the era of highly active antiretroviral
therapy: successful management with intravitreal injections and monitoring with
quantitative PCR.

Yin PD, Kurup SK, Fischer SH, Rhee HH, Byrnes GA, Levy-Clarke GA, Buggage RR,
Nussenblatt RB, Mican JM, Wright ME.

National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
pdyin@mail.nih.gov

BACKGROUND: Progressive outer retinal necrosis (PORN) is an ocular disease in
individuals with AIDS and is associated with substantial morbidity. The optimal
management of PORN and its clinical course in the HAART era is unclear.
OBJECTIVE: We report a case of successfully managed PORN that provides insight
into the monitoring and treatment of this disease. STUDY DESIGN: Intravitreal
injections and intravenous therapy targeted towards varicella zoster virus (VZV) 
were used to treat PORN. HAART was initiated for HIV-1 therapy. Serial PCR for
VZV was performed on aqueous humor to monitor the clinical course. RESULTS: The
presence of VZV DNA from aqueous humor correlated with clinical exacerbations of 
disease. Initiation of twice weekly intravitreal injections with dual antiviral
drugs appeared to be an important therapeutic intervention that resulted in
remission of PORN. Secondary prophylaxis against VZV was successfully withdrawn
after HAART induced partial immune recovery. CONCLUSION: In addition to
aggressive therapy with intravitreal injections, HAART and quantitative
measurements of VZV DNA from aqueous humor have important roles in the management
of PORN. A multidisciplinary approach involving specialists in infectious
diseases, ophthalmology, and clinical microbiology will improve the chances for
successful long-term outcomes.

Publication Types: 
    Case Reports

PMID: 17280866 [PubMed - indexed for MEDLINE]

297: Otolaryngol Head Neck Surg. 2007 Feb;136(2):313-4.

Comment in:
    Otolaryngol Head Neck Surg. 2007 Jun;136(6):1027.

Hutchinson sign and herpes zoster.

Murrell GL, Hayes BH.

Naval Hospital Camp Pendleton California, Camp Pendleton, CA, and Uniformed
Services University of the Health Sciences, Bethesda, MD, USA.
glmurrell@cpen.med.navy.mil

Publication Types: 
    Case Reports

PMID: 17275563 [PubMed - indexed for MEDLINE]

298: Rev Med Interne. 2007 Mar;28(3):166-72. Epub 2007 Jan 17.

[Immunization of adults against varicella and herpes zoster]

[Article in French]

Hanslik T, Blanchon T, Alvarez FP.

Service de Medecine Interne, Hopital Ambroise-Pare, Universite
Versailles-Saint-Quentin-en-Yvelines, Assistance publique-Hopitaux de Paris, 9,
avenue Charles-de-Gaulle, 92104 Boulogne Billancourt cedex, France.
thomas.hanslik@apr.aphp.fr

PURPOSE: Following the commercialisation in France of the varicella vaccine and
the European marketing authorization for a vaccine against zoster, this article
intends to review the epidemiology of varicella and herpes zoster, to expose the 
characteristics of the available vaccines, and to consider the advantages and
caveats of the different immunisation strategies. CURRENT KNOWLEDGE AND KEY
POINTS: In France, from 550.000 to 750.000 cases of varicella are reported each
year, which result in more than 3.500 hospitalizations and about 20 deaths.
Subjects>or=15 years old represent 8.3% of the total number of cases of
varicella, 26% of varicella-related hospitalisations and 69% of all
varicella-related deaths. The susceptibility rate for the 15 years old is 10,3
and 79% of these non-immune subjects are expected to contract varicella. The
vaccines currently marketed against varicella are safe, have a good
immunogenicity and remain effective over the evaluated periods. Two vaccination
strategies are considered: a generalized vaccination of the infants and children,
or a vaccination targeted against high-risk populations and non-immune teenagers 
and adults. The incidence of herpes zoster is estimated in France at 235.000 new 
cases per year, from which 1% is hospitalized. A live attenuated vaccine using
the same strain as the varicella vaccine, but at a much higher dose, proved its
efficacy in terms of reducing shingles and postherpetic neuralgia incidences, of 
51 and 67% respectively. This vaccine received a marketing authorisation in
France, for adults>or=60 years old. FUTURE PROSPECTS: Uncertainties about the
impact of vaccination on varicella and herpes zoster epidemiology have yet to be 
solved, such as the potential increase in herpes zoster incidence or in the
absolute number of diagnosed varicella cases in older age groups, or the loss of 
vaccination-induced immunity with time. These questions demonstrate the need for 
an operational real-time surveillance network to monitor varicella and herpes
zoster incidence in the setting of general population immunisation.

Publication Types: 
    English Abstract
    Review

PMID: 17270316 [PubMed - indexed for MEDLINE]

299: Pediatr Ann. 2007 Jan;36(1):21-9.

Childhood viral exanthems.

Dyer JA.

Department of Dermatology, University of Missorui, Columbia, MO, USA.
dyerja@health.missouri.edu

Many viral infections exhibit cutaneous lesions. Recognition of the exanthems
associated with these infections and the broader clinical scenarios in which they
occur can lead to more rapid diagnosis and appropriate treatment for affected
patients.

PMID: 17269280 [PubMed - indexed for MEDLINE]

300: Georgian Med News. 2006 Dec;(141):50-3.

Peculiarities of herpes zoster in immunocompetent and immunocompromised hosts.

Sharvadze L, Tsertsvadze T, Gochitashvili N, Bolokadze N, Dolmazashvili E.

Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi,
Georgia.

The aim of five years (2000-2005) study was to investigate the peculiarities of
Herpes Zoster in immunocompromised and immunocompetent patients. For this purpose
we have investigated the clinical course of Herpes Zoster, disease duration,
complications of disease, as in acute phase as well as postherpetic neuralgia in 
74 HIV positive (1st group) and 74 HIV negative (2nd group) groups of patients.
In both group of patients we have studied the prevalence of the following
complications: 1. Acute complications of Herpes Zoster: a) Neurological: motor
neuropathy, cranial neuritis, meningoencephalitis, transverse myelitis. b)
Ophthalmic: keratitis, iritis, retinitis, visual impairment c) Cutaneous:
bacterial superinfection, scarring, disfigurement. d) Visceral: pneumonitis,
hepatitis. e) Multidermatomal. 2. The complications of after resolution of
infection: a) Postherpetic neuralgia and various duration of pain associated with
postherpetic neuralgia such as : < month, 1-6 months, 6-12 months and >1 year
durations. b) Recurrent herpes zoster. Herpes Zoster infection was diagnosed
based on clinical symptoms and by detection of VZV specific IgM and IgG by ELISA.
HIV infection was diagnosed by ELISA method and was confirmed by Western Blot. We
found that Herpes Zoster may develop as in HIV positive as well as HIV negative
population. Study showed that severe cases of disease (Herpes Zoster), long
duration and rate of complications are much higher in HIV/AIDS than in HIV
negative group patients. Rate of hospitalization is also higher in HIV/AIDS
patients with Herpes Zoster than in HIV negative patients with Herpes Zoster.
Frequency of recurrent Herpes Zoster is much higher in HIV/AIDS patients than in 
HIV negative patients. The postherpetic neuralgia is very frequent complication
for both group (HIV positive and HIV negative) Herpes Zoster patients, but its
duration longer in HIV/AIDS patients in comparison HIV negative group. There were
no significant difference in disease severity, duration and complications among
male and female patients.

PMID: 17261887 [PubMed - indexed for MEDLINE]

301: Neurology. 2007 Jan 30;68(5):E4.

Spinal myoclonus following herpes zoster radiculitis.

Estraneo A, Saltalamacchia AM, Loreto V.

Salvatore Maugeri Foundation, IRCCS Via Bagni Vecchi, 82037 Telese Terme (BN),
Italy. aestraneo@fsm.it

Publication Types: 
    Case Reports

PMID: 17261675 [PubMed - indexed for MEDLINE]

302: Enferm Infecc Microbiol Clin. 2007 Jan;25(1):69-70.

[Ramsay-Hunt syndrome complicated with cerebral venous thrombosis in an
HIV-1-infected patient]

[Article in Spanish]

Pazos-Anon R, Machado-Costa C, Farto E Abreu J.

Publication Types: 
    Case Reports
    Letter

PMID: 17261251 [PubMed - indexed for MEDLINE]

303: Manag Care. 2006 Dec;15(12):57-8.

Herpes zoster vaccine brings relief for the elderly.

Morrow T.

Genentech Inc.

PMID: 17260848 [PubMed - indexed for MEDLINE]

304: Rinsho Shinkeigaku. 2006 Sep;46(9):668-70.

[Case of zoster sine herpete presenting with dysphagia diagnosed by PCR analysis 
of VZV DNA in auricular skin exudates]

[Article in Japanese]

Yaguchi H, Hisatomi M, Sekine T, Matsui K, Nagatomo M, Inoue K.

Department of Neurology, The Jikei University Kashiwa Hospital.

A 66-year-old woman was admitted to our hospital because of hoarseness and
dysphagia after right earache and pharyngalgia. She showed right glossopharyngeal
nerve and vagus nerve palsies, but no other neurological deficits. There was no
skin rash within the regions of her ear, oral cavity, pharynx and larynx. Slight 
increase of mononuclear cells was noted in the cerebrospinal fluid. MR brain
imaging was normal. We diagnosed her as zoster sine herpete (ZSH) and treated her
with acyclovir, after which she almost completely recovered. The examination of
antibodies and DNA of varicella zoster virus (VZV) in the serum and cerebrospinal
fluid revealed a pattern of previous zoster infection without evidences of
reactivation. However, VZV DNA was detected in auricular skin exudates with PCR. 
We conclude that PCR analysis of VZV DNA in auricular skin exudates can be a
useful diagnostic tool for the diagnosis of zoster sine herpete presenting with
painful glossopharyngeal nerve and vagus nerve palsies.

Publication Types: 
    English Abstract

PMID: 17260814 [PubMed - indexed for MEDLINE]

305: Rinsho Shinkeigaku. 2006 Sep;46(9):664-7.

[Case of herpes zoster associated Guillain-Barre syndrome with a relapse of
eruptions after intravenous immunoglobulin therapy]

[Article in Japanese]

Nagane Y, Utsugisawa K, Obara D.

Department of Neurology, Hanamaki General Hospital.

A 77-year-old woman developed progressive dysesthesia, hypesthesia and weakness
in four extremities immediately after improvement of herpes zoster in the left
Th10 dermatome area. Examination of the cerebrospinal fluid (CSF) showed an
increase in protein concentrations. Evidence of demyelinating polyneuropathy was 
demonstrated by nerve conduction studies. Her hypesthesia and weakness in the
extremities were gradually improved following intravenous immunoglobulin therapy 
(IVIg). Varicella zoster virus (VZV) titer levels in CSF well correlated both
with neurological symptoms and CSF protein concentrations. VZV DNA in the CSF was
not detectable. These findings suggested autoimmune Guillain-Barre syndrome (GBS)
associated with herpes zoster. An interesting finding in the present patient is
that one day after the completion of IVIg, when the neurological symptoms in the 
extremities were apparently ameliorating, the herpes zoster eruptions again
emerged in the left L3 dermatome area. By treatment with intravenous acyclovir,
the vesicular eruptions were improved. We assume that IVIg might suppress the
immune response against VZV and promote the recurrence of eruptions.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17260813 [PubMed - indexed for MEDLINE]

306: Vaccine. 2007 Mar 1;25(11):2139-44. Epub 2006 Nov 27.

Safety and immunogenicity of a zoster vaccine in varicella-zoster virus
seronegative and low-seropositive healthy adults.

Macaladad N, Marcano T, Guzman M, Moya J, Jurado F, Thompson M, Meechan C, Li D, 
Schlienger K, Chan I, Sadoff J, Schodel F, Silber JL.

De la Salle University Medical Center, Cavite, Philippines.

OBJECTIVE: To evaluate immunogenicity and tolerability of a live attenuated
zoster vaccine in varicella-zoster virus (VZV) seronegative or low-seropositive
adults > or = 30 years of age. STUDY DESIGN: Double-blind, placebo-controlled,
randomized, multicenter study. Subjects were enrolled in two stages by
prescreened serostatus. Subjects with a low VZV antibody titer (< or = 5 gpELISA 
units/mL) were enrolled in Stage 1. Subjects with undetecable VZV antibodies and 
no safety issues identified during Stage 1 were enrolled in Stage 2. All enrolled
subjects were randomized 4:1 to receive one dose (approximately 50,000 PFU) of
zoster vaccine or placebo and were followed for safety for 42 days
postvaccination. Primary objectives/hypotheses: (1) no vaccine-related serious
adverse experiences (AE); (2) < or = 1 laboratory-confirmed varicella-like rash
with > 50 lesions within 42 days postvaccination. Secondary objective: summarize 
the VZV antibody response postvaccination. RESULTS: Twenty-one subjects (age 27
to 69 years; median 34) enrolled (1148 prescreened); 18 (including 4 seronegative
subjects) received vaccine and 3 (including 1 seronegative subject) received
placebo. Twenty subjects completed the study; one subject withdrew for reasons
unrelated to safety. No serious vaccine-related AE or laboratory-confirmed
varicella-like rashes with > 50 lesions were reported. In the zoster vaccine
group, all 4 of the initially seronegative subjects (age 32 to 36 years; median
33.5) seroconverted and 6 of the 13 (46.2%) initially seropositive subjects had a
> or = 4-fold rise in VZV-specific antibody titer at 6 weeks postvaccination.
CONCLUSIONS: The zoster vaccine appears to be immunogenic and generally well
tolerated in healthy adults > or = 30 years of age, regardless of initial VZV
antibody serostatus.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 17250932 [PubMed - indexed for MEDLINE]

307: Pharmacoeconomics. 2007;25(2):155-69.

Acute/subacute herpes zoster: healthcare resource utilisation and costs in a
group of US health plans.

Insinga RP, Itzler RF, Pellissier JM.

Department of Health Economic Statistics, Merck Research Laboratories, North
Wales, Pennsylvania 19454-1099, USA. ralph_insinga@merck.com

BACKGROUND: Although there are estimated to be nearly 1 million cases of herpes
zoster diagnosed in the US each year, the economic costs associated with herpes
zoster in the US have not been well described. OBJECTIVE: To describe the
healthcare resource utilisation and costs associated with physician-diagnosed
acute/subacute herpes zoster, from a payer perspective, using a large US
healthcare claims database. METHODS: Data for the period 2000-1 were obtained
from the Medstat Marketscan healthcare claims database. The duration of
acute/subacute herpes zoster was considered to include the 21 days preceding, and
90 days following, the initial herpes zoster diagnosis. Resource utilisation was 
examined for individuals with newly diagnosed acute/subacute herpes zoster (n =
8741) and compared, through regression analyses, with that observed for control
individuals from the same population (n = 50,000). Similar analyses were
conducted for costs; the costs included reflected healthcare payments from
patients, insurers and other sources. Regression analyses controlled for
demographics (age, gender), conditions that have been observed with greater
frequency among patients with acute/subacute herpes zoster in prior studies
(cancer, HIV infection, organ transplantation, other immunosuppressive conditions
and therapies) and the number of billed services within each of seven categories 
of care that were potentially related to acute/subacute herpes zoster and that
were utilised within the 30-180 days prior to the diagnosis for affected
patients, and over an analogous period for controls. RESULTS: The acute/subacute 
phase of herpes zoster was estimated to result in an average of 1.7 (standard
error [SE] 0.02) additional physician and hospital outpatient visits, 0.05 (SE
0.003) additional emergency room visits, 0.03 (SE 0.003) additional inpatient
hospital admissions, 2.1 (SE 0.03) additional prescriptions filled and $US431 (SE
17.60) in additional healthcare costs per patient. Among patients with
acute/subacute herpes zoster, 21.1% had a diagnosis code with a designation for a
herpes zoster-related complication, and 9.4% had three or more outpatient visits 
with a diagnosis code for herpes zoster. The average estimated incremental costs 
per patient with acute/subacute disease increased with age, ranging from $US258
(SE 37.70) among patients aged < or =19 years to $US805 (SE 106.30) among those
aged > or =80 years. The numbers of additional outpatient visits, inpatient
admissions, prescriptions filled for pain medications and coded complications
were also substantially higher among older than younger patients with
acute/subacute herpes zoster. CONCLUSIONS: The management of acute/subacute
herpes zoster was found to result in substantial healthcare costs, with
outpatient care and prescription drugs comprising the majority of the cost
burden. To more fully understand the overall cost of herpes zoster disease to
society, future studies should examine the healthcare costs associated with
post-herpetic neuralgia and productivity losses due to herpes zoster and
post-herpetic neuralgia.

PMID: 17249857 [PubMed - indexed for MEDLINE]

308: Singapore Med J. 2007 Jan;48(1):e16-8.

Herpes zoster complicating imatinib mesylate for gastrointestinal stromal tumour.

Durosinmi MA, Ogbe PO, Salawu L, Oyekunle AA.

Departments of Haematology and Blood Transfusion, Obafemi Awolowo University
Teaching Hospital, Ile-Ife, Nigeria. mdurosin@yahoo.com

Varicella zoster virus (VZV) infection is uncommon in patients with
gastrointestinal stromal tumour (GIST) and who have not been exposed to extensive
radiotherapy and/or high-dose chemotherapy. We report a 56-year-old Nigerian man 
with GIST who developed VZV infection while on imatinib mesylate therapy. From
August 2003 to November 2005, 64 patients (GIST/CML = 6/58) were enrolled into an
ongoing Glivec (imatinib mesylate) international patient-assistance programme
therapy for Philadelphia/bcr-abl-positive chronic myeloid leukaemia (CML) and
CD117-positive GIST patients at Obafemi Awolowo University Teaching Hospitals
Complex, Ile-Ife, Nigeria. The patient developed herpes zoster (HZ) infection 23 
months into therapy with Glivec. With his absolute lymphocyte count at 2,774
cells per microlitre and CD4 count at 950 cells per microlitre, no obvious
immunological defect was observed. Prompt resolution of symptoms without sequelae
was achieved by treating with acyclovir, analgesic and dressing of lesions with
desiccant. To our knowledge, this is the first reported case of HZ infection in a
patient with GIST on Glivec therapy, and the response is similar to that of CML
patients who developed VZV while on similar therapy.

Publication Types: 
    Case Reports

PMID: 17245498 [PubMed - indexed for MEDLINE]

309: Pain Med. 2007 Jan-Feb;8(1):36-40.

Effectiveness of prostaglandin E1 for the treatment of patients with neuropathic 
pain following herpes zoster.

Kanai A, Osawa S, Suzuki A, Ishimaru R, Hoka S.

Department of Anesthesiology, Kitasato University School of Medicine, Japan.
Kanaiakifumi@aol.com

OBJECTIVE: Postherpetic neuralgia (PHN) is one of the most painful neuropathic
conditions, the mechanism of which remains unclear. There is no universally
accepted treatment. The pain in PHN is often relieved by bathing, heating, or
sympathetic blockade, suggesting a circulation-dependent property of the pain.
Therefore, we examined the effectiveness of prostaglandin E(1) (PGE(1)), which
has an analgesic effect via improvement of peripheral blood circulation, for
patients with PHN. DESIGN: A total of 27 patients with PHN underwent intravenous 
administration of 60 microg of PGE(1) dissolved in 100 mL of physiological saline
and 5 mL of 8.4% sodium bicarbonate solution at an infusion rate of 0.02
microg/kg/min. Oral administration of PGE(1), limaprost alfadex, was followed at 
doses of 30 microg/day for 2 weeks. Pain at rest and tactile allodynia before and
after the treatment was evaluated with visual analog scale (VAS). RESULTS:
Intravenous PGE(1) significantly decreased VAS in rest pain and tactile allodynia
without severe adverse effects. The analgesic effect of PGE(1) continued during
the 2 weeks of oral administration of PGE(1). Oral PGE(1) caused nausea in seven 
cases, diarrhea in three, and abdominal distention in one subject. All subjects, 
except for two cases of nausea, continued the treatment until the end of the
study, although some required a decrease in the dose to 15 microg/day. During the
2-week oral administration, the VAS did not change remarkably in the three
patients whose VAS were not decreased by at least 80% during the initial
infusion. CONCLUSIONS: The results of the present study indicate that oral PGE(1)
following the intravenous administration produces prompt and continuous analgesia
in patients with PHN. Moreover, the intravenous treatment using PGE(1) appears
useful for predicting the analgesic effect of PGE(1) in the patients.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 17244102 [PubMed - indexed for MEDLINE]

310: J Travel Med. 2007 Jan-Feb;14(1):65-6.

Herpes zoster after yellow fever vaccination.

Bayas JM, Gonzalez-Alvarez R, Guinovart C.

Preventive Medicine Service, International Vaccination Centre, Hospital
Clinic-IDIBAPS, Barcelona, Spain. jmbayas@cliic.ub.es

An immunocompetent 64-year-old women presented with brachial herpes zoster (HZ)
infection 3 days after vaccination against yellow fever (YF). The lesions
disappeared after antiviral treatment. There are very few reports of a possible
association between YF vaccination and HZ infection. This case supports the
importance of continuing surveillance of vaccine adverse events.

Publication Types: 
    Case Reports

PMID: 17241257 [PubMed - indexed for MEDLINE]

311: Pain. 2007 Mar;128(1-2):189-90; author reply 190-2. Epub 2007 Jan 19.

Comment on:
    Pain. 2007 Mar;128(1-2):148-56.

Inadequate evidence for a revised definition of postherpetic neuralgia (PHN).

Dworkin RH.

Publication Types: 
    Comment
    Letter

PMID: 17240068 [PubMed - indexed for MEDLINE]

312: Top HIV Med. 2006 Dec-2007 Jan;14(5):154-8.

Immunizations for HIV-infected adults: indications, timing, and response.

Spach DH.

University of Washington, Seattle, WA, USA.

Vaccines routinely recommended for HIV-infected adults include those for
influenza, hepatitis A virus, hepatitis B virus, pneumococcal infection, and
tetanus. Responses to vaccination may be affected by CD4+ cell count and viral
load. A number of live vaccines are contraindicated in the HIV-infected
population. This article summarizes a presentation on immunization in
HIV-infected adults made by David H. Spach, MD, at the 9th Annual Ryan White CARE
Act Clinical Update in Washington, DC, in August 2006. The original presentation 
is available as a Webcast at www.iasusa.org.

Publication Types: 
    Case Reports

PMID: 17237556 [PubMed - indexed for MEDLINE]

313: Drugs Aging. 2007;24(1):1-19.

Post-herpetic neuralgia in older adults: evidence-based approaches to clinical
management.

Christo PJ, Hobelmann G, Maine DN.

Department of Anesthesiology and Critical Care Medicine, Division of Pain
Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
21205, USA. pchristo@jhmi.edu

Many individuals across the globe have been exposed to the varicella-zoster virus
(VZV) that causes chickenpox. After chickenpox has resolved, the virus remains
latent in the dorsal root ganglia where it can re-emerge later in life as herpes 
zoster, otherwise known as shingles. Herpes zoster is a transient disease
characterised by a dermatomal rash that is usually associated with significant
pain. Post-herpetic neuralgia (PHN) is the term used for the condition that
exists if the pain persists after the rash has resolved. Advanced age and
compromised cell-mediated immunity are significant risk factors for reactivation 
of herpes zoster and the subsequent development of PHN. Though the
pathophysiology of PHN is unclear, studies suggest peripheral and central
demyelination as well as neuronal destruction are involved. Both the vaccine
against VZV (Varivax) and the newly released vaccine against herpes zoster
(Zostavax) may lead to substantial reductions in morbidity from herpes zoster and
PHN. In addition, current evidence suggests that multiple medications are
effective in reducing the pain associated with PHN. These include tricyclic
antidepressants, antiepileptics, opioids, NMDA receptor antagonists as well as
topical lidocaine (lignocaine) and capsaicin. Reasonable evidence supports the
use of intrathecal corticosteroids, but the potential for neurological sequelae
should prompt caution with their application. Epidural corticosteroids have not
been shown to provide effective analgesia for PHN. Sympathetic blockade may
assist in treating the pain of herpes zoster or PHN. For intractable PHN pain,
practitioners have performed delicate surgeries and attempted novel therapies.
Although such therapies may help reduce pain, they have been associated with
disappointing results, with up to 50% of patients failing to receive acceptable
pain relief. Hence, it is likely that the most effective future treatment for
this disease will focus on prevention of VZV infection and immunisation against
herpes zoster infection with a novel vaccine.

Publication Types: 
    Review

PMID: 17233544 [PubMed - indexed for MEDLINE]

314: J Infect Dis. 2007 Feb 15;195(4):502-10. Epub 2007 Jan 10.

Comment in:
    J Infect Dis. 2007 Sep 1;196(5):801-2; author reply 802-3.

DNA sequence variability in isolates recovered from patients with postvaccination
rash or herpes zoster caused by Oka varicella vaccine.

Loparev VN, Rubtcova E, Seward JF, Levin MJ, Schmid DS.

National Center for Immunizations and Respiratory Diseases, Centers for Disease
Control and Prevention, Atlanta, GA 30333, USA.

Little is known about the pathogenic potential of individual strains in the
varicella vaccine. We analyzed genomic variation among specimens obtained from
vaccine recipients with postvaccination rash or herpes zoster (HZ), focusing on
polymorphisms between live attenuated varicella vaccine virus and wild-type
varicella-zoster virus. Eleven of 18 postvaccination HZ specimens contained >1
strain, and 7 of 18 appeared to be clonal. All 21 postvaccination rash specimens 
contained mixtures of vaccine strains. Four single-nucleotide polymorphisms
(SNPs) consistently occurred in every isolate; all were polymorphisms in
open-reading frame (ORF) 62, and 2 confer amino acid substitutions in the
immediate-early protein 62. Four wild-type SNPs occurred in every isolate: one
each occurred in ORF 10, ORF 21, ORF 62, and a noncoding region upstream of ORF
64. The frequencies of the remaining wild-type SNPs were variable, with the SNPs 
uniformly expressed (even in mixtures) in 20.5%-97.4% of isolates (mean
frequency, 67.7%). No 2 clinical isolates had identical SNP profiles; as such,
vaccine latency usually involves >1 strain.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 17230409 [PubMed - indexed for MEDLINE]

315: Health News. 2006 Nov;12(11):12.

I've had one bout with shingles. Can I get it again? Can I prevent it?

[No authors listed]

PMID: 17228401 [PubMed - indexed for MEDLINE]

316: Vaccine. 2007 Feb 26;25(10):1877-83. Epub 2006 Oct 30.

Safety and tolerability of a high-potency zoster vaccine in adults >/= 50 or
years of age.

Tyring SK, Diaz-Mitoma F, Padget LG, Nunez M, Poland G, Cassidy WM, Bundick ND,
Li J, Chan IS, Stek JE, Annunziato PW; Protocol 009 Study Group.

University of Texas Health Science Center, Houston, TX, USA.

BACKGROUND: Herpes zoster (HZ) incidence rises with age, especially after 50
years of age, probably due to waning varicella-zoster virus (VZV)-specific
immunity. The Shingles Prevention Study [Oxman MN, Levin MJ, Johnson GR, Schmader
KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and
postherpetic neuralgia in older adults, N Engl J Med 2005;352:2271-84], enrolled 
people >/= 60 or years of age and showed that zoster vaccine prevents HZ and
postherpetic neuralgia (PHN), presumably through boosting VZV-specific immunity. 
This study of people >/= 50 or years of age compared the safety and tolerability 
of two zoster vaccine potencies. METHODS: Adults >/= 50 or years old enrolled in 
a randomized, double-blind, multicenter study to compare the safety and
tolerability of one dose of two zoster vaccine potencies, approximately 58,000
and approximately 207,000 plaque-forming units/dose. Adverse experiences (AEs)
were recorded on a standardized Vaccination Report Card for 42 days
postvaccination. For assessment of injection-site AEs, clinically acceptable
tolerability was predefined based on experience with PNEUMOVAX 23, a licensed
vaccine recommended for use in older people. RESULTS: Six hundred and
ninety-eight subjects (age 50-90 years, median 64 years) were enrolled. No
serious vaccine-related AEs were reported. Similar AE rates were observed in the 
higher and lower potency groups (overall systemic AEs: 37.5 and 39.3%,
vaccine-related systemic AEs: 10.9 and 13.2%, injection-site AEs: 63.0 and
59.8%). Rates for a combined endpoint of moderate or severe injection-site
pain/tenderness/soreness and swelling were 17.2% (95% CI 13.9, 21.0) and 9.0%
(95% CI 5.6, 13.4), respectively. Most combined endpoint events were reported as 
moderate in intensity. CONCLUSIONS: Both vaccine potencies were generally well
tolerated in this study of people > or years of age. Although rates of some
moderate or severe injection-site AEs were greater in the higher potency group,
all rates met the prespecified criteria for clinically acceptable tolerability.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial

PMID: 17227688 [PubMed - indexed for MEDLINE]

317: Am J Med Sci. 2007 Jan;333(1):56-7.

Herpes zoster ophthalmicus and syndrome of inappropriate antidiuretic hormone
secretion.

Dhawan SS.

Department of Internal Medicine, University of Tennessee Health Science Center,
Memphis, Tennessee 38103, USA. csaurabh@gmail.com

Presented here is a case of syndrome of inappropriate antidiuretic hormone
secretion (SIADH) that developed in an elderly woman with single dermatomal
herpes varicella zoster ophthalmicus without evidence of varicella-zoster
encephalitis or dissemination. This is only the third such case reported in the
English language literature to date, and it affirms that SIADH can develop in
patients with herpetic involvement of just a single dermatome and corrects with
resolution of the herpetic lesions.

Publication Types: 
    Case Reports
    Review

PMID: 17220695 [PubMed - indexed for MEDLINE]

318: Ostomy Wound Manage. 2006 Dec;52(12):14-6.

Use of an atraumatic dressing in the treatment of a painful wound resulting from 
herpes zoster.

Serena TE.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 17219697 [PubMed - indexed for MEDLINE]

319: Dtsch Med Wochenschr. 2007 Jan 19;132(3):95-6.

[Reactivation of varicella-zoster-virus in the area of the left vagus nerve
(herpes zoster)]

[Article in German]

Helmstaedter V, Preuss SF.

Publication Types: 
    Case Reports

PMID: 17219343 [PubMed - indexed for MEDLINE]

320: Neurologist. 2007 Jan;13(1):43-4.

Shingles.

Kernich CA.

Department of Medicine, University Hospitals Medical Group, University Hospitals,
Cleveland, Ohio, USA.

PMID: 17215727 [PubMed - indexed for MEDLINE]

321: Lakartidningen. 2006 Nov 22-28;103(47):3702-3.

[Sensory innervation of the back incorrectly described in dermatomal maps]

[Article in Swedish]

Dahlgren N.

Onkologiska kliniken, Universitetssjukhuset i Lund. helgonavagen18@msn.com

PMID: 17212317 [PubMed - indexed for MEDLINE]

322: Saudi Med J. 2007 Jan;28(1):125-7.

Sudden onset of herpes zoster following chemotherapy for orbital lymphoma in a
HIV positive patient.

Omoti AE, Omoti CE.

Department of Ophthalmology, University of Benin Teaching Hospital, Benin City,
Nigeria. ediomoti@yahoo.com

We report a 38-year-old HIV positive female, who developed an acute attack of
herpes zoster HZ involving the mandibular, C2, C3, C4, T1, and T2 dermatomes, 9
days after the commencement of the first cycle of chemotherapy regimen for
non-Hodgkin's lymphoma NHL. She had developed NHL of the ovary approximately 6
months earlier, followed by metastasis to the left orbit resulting in proptosis
of the left eye. A combination of a positive HIV status, lymphoma, and
chemotherapy can predispose a patient to an attack of HZ involving many
dermatomes.

Publication Types: 
    Case Reports

PMID: 17206304 [PubMed - indexed for MEDLINE]

323: J Dermatol Sci. 2007 Mar;45(3):213-5. Epub 2007 Jan 3.

Polymorphism of the IL-10 gene is associated with susceptibility to herpes zoster
in Korea.

Cho JW, Shin DH, Lee KS.

Publication Types: 
    Letter
    Research Support, Non-U.S. Gov't

PMID: 17204399 [PubMed - indexed for MEDLINE]

324: J Dermatol. 2007 Jan;34(1):68-73.

Zosteriform skin involvement of nodal T-cell lymphoma: a review of the published 
work of cutaneous malignancies mimicking herpes zoster.

Niiyama S, Satoh K, Kaneko S, Aiba S, Takahashi M, Mukai H.

Department of Dermatology, Yokohama Rosai Hospital, and Kitasato University,
Kanagawa, Japan. sniiyama@aol.com

A 77-year-old Japanese woman initially presented with non-Hodgkin's lymphoma
involving her neck, axillary and inguen lymph nodes. She had edematous erythema
and nodules limited to the skin in zosteriform distribution on the left side
chest wall along the T4-5 dermatome. In addition, since 1970, we have mainly been
collecting English-language articles on malignant skin tumors and skin metastasis
described as zosteriform in the title, and we have reviewed a total of 29 cases, 
including our own. It should be mentioned that 59% of the cases reported had been
diagnosed with herpes zoster at the time of the initial examination and that many
of them had received drug therapy (e.g. acyclovir). We wish to add the dermatomic
eruption mimicking zoster sine herpete to the list of possible presentations of
cutaneous malignancies.

Publication Types: 
    Case Reports
    Review

PMID: 17204106 [PubMed - indexed for MEDLINE]

325: Z Orthop Ihre Grenzgeb. 2006 Nov-Dec;144(6):583-6.

[Rare differential diagnosis of a radicular spine syndrome: herpes zoster
radiculitis]

[Article in German]

Koch P, Diedrich O, Pennekamp PH, Schmitz A.

Klinik und Poliklinik fur Orthopadie, Universitatsklinikum Bonn, Germany.
peter.koch@ukb.uni-bonn.de

We report on the case of a 66-year-old patient who was hospitalized because of
intractable low back pain radiating into the right leg. Leg pain was accompanied 
by a numbness and muscle weakness which was clearly assigned to the L5 dermatome.
Concerning the patient's medical history a nucleotomy L4/5 and a
osteomyelofibrosis were known. MRI of the lumbar spine revealed a multisegmental 
stenosis which was pronounced on the level L4/5. One day after admission of the
patient to the hospital a typical zoster exanthema involving the L5 dermatome
appeared. Varicella-zoster virus (VZV) was detected in the fluid of the vesicular
skin lesions by polymerase chain reaction. Intravenous administration of
aciclovir lead to rapid decrease of pain and exanthema. A few months later the
patient died because of an acute myeloid leukemia as a complication of the known 
osteomyelofibrosis. This case report shows that a herpes zoster infection can
imitate a radicular spine syndrome usually caused by degenerative changes.
Especially in immunocompromised patients, a zoster radiculitis should be included
in the differential diagnosis of radiculopathy. VZV infection might also occur
without skin lesions (zoster sine herpete) so that serological assays for the
early detection of virus DNA can be useful.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17187332 [PubMed - indexed for MEDLINE]

326: Ophthalmology. 2007 Apr;114(4):756-62. Epub 2006 Dec 20.

Acute retinal necrosis features, management, and outcomes.

Lau CH, Missotten T, Salzmann J, Lightman SL.

Department of Clinical Ophthalmology, Institute of Ophthalmology and Moorfields
Eye Hospital, London, United Kingdom.

OBJECTIVE: To determine the viral diagnosis and factors affecting the visual
outcome of eyes with acute retinal necrosis. DESIGN: Nonrandomized,
retrospective, interventional, noncomparative series. PARTICIPANTS: A cohort of
22 human immunodeficiency virus-negative patients with acute retinal necrosis
(ARN). There were 17 unilateral and 5 bilateral cases. INTERVENTION: Diagnostic
vitreous biopsy for polymerase chain reaction (PCR) viral DNA analysis,
prophylactic barrier laser posterior to necrotic retina to try to prevent
rhegmatogenous retinal detachment (RD), intravenous acyclovir in combination with
oral, and vitrectomy for RD repair. MAIN OUTCOME MEASURES: Results of PCR viral
DNA analysis, relationship between prophylactic barrier argon laser
photocoagulation and occurrence of RD, and visual acuities at presentation and
follow-up. RESULTS: Varicella-zoster virus (VZV) was detected in 66.7% (12/18) of
eyes (66.7% of patients [10/15]) with vitreous biopsy and herpes simplex virus
(HSV) in 22.2% (4/18) of eyes (20% of patients [3/15]). Epstein-Barr virus (EBV) 
was detected in 16.7% (3/18) of eyes (20% of patients [3/15]), and all the
EBV-positive eyes were also positive for VZV. Polymerase chain reaction results
were identical in both eyes of bilateral cases (5 patients) and were negative in 
11.1% (2/18) of eyes (13.3% of patients [2/15]) biopsied. Systemic corticosteroid
treatment given before ARN diagnosis did not appear to increase the risk of
developing RD (P = 0.69). Rhegmatogenous RD occurred in 35.3% (6/17) of eyes
given prophylactic argon laser treatment and in 80% (8/10) of eyes that could not
be lasered prohylactically. Of RDs, 96.3% (13/14) occurred after the third week
and up to 5 months from onset of symptoms. The VA after surgical repair of RD
improved relative to the presentation acuity in 33.3% (4/12) of eyes. CONCLUSION:
Varicella-zoster virus is the leading cause of ARN. We recommend the management
of ARN to include prompt diagnosis; prophylactic argon laser retinopexy,
preferably within the first 2 weeks to reduce risk of RD; systemic acyclovir; and
corticosteroids to control the severe inflammation associated with ARN. Despite
the guarded visual prognosis, RD repair may result in improved visual outcomes.

PMID: 17184841 [PubMed - indexed for MEDLINE]

327: J Pain Palliat Care Pharmacother. 2006;20(4):41-2.

Zoster vaccine to prevent postherpetic neuralgia.

Sederholm B, Peterson D.

Drug Information Service, University of Utah, Salt Lake City, UT 84108, USA.

In 2006, the U.S. Food and Drug Administration approved the first vaccine for the
prevention of acute herpes zoster neuralgia (shingles). This vaccine has
important implications in reducing the incidence and severity of the common
neuropathic pain condition postherpetic neuralgia. The new vaccine is described.

Publication Types: 
    Randomized Controlled Trial

PMID: 17182505 [PubMed - indexed for MEDLINE]

328: Drugs. 2006;66(18):2397-416.

Famciclovir: a review of its use in herpes zoster and genital and orolabial
herpes.

Simpson D, Lyseng-Williamson KA.

Wolters Kluwer Health | Adis, Auckland, New Zealand. demail@adis.co.nz

Famciclovir (Famvir) is the oral prodrug of penciclovir, an agent that has
demonstrated antiviral activity against herpes simplex viruses, type 1 (HSV-1)
and 2 (HSV-2) [which cause orolabial and/or genital herpes simplex], and against 
varicella zoster virus (VZV) [a reactivation of which leads to herpes zoster].
Famciclovir has efficacy similar to that of aciclovir (in immunocompetent or
immunocompromised patients) or valaciclovir (in immunocompetent patients) in the 
treatment of herpes zoster, and efficacy similar to aciclovir in the treatment of
first or recurrent episodes of genital herpes (in immunocompetent or
immunocompromised patients). Famciclovir also has efficacy in the suppression of 
recurrent episodes of genital herpes, and in the treatment of orolabial herpes,
in immunocompetent patients. As such, famciclovir is a well tolerated first-line 
option for the treatment of herpes zoster and the treatment and suppression of
genital herpes, and is approved for the treatment of recurrent orolabial herpes. 
Convenient patient-initiated single-day (for recurrent genital herpes) and
single-dose (for orolabial herpes) dosage regimens may contribute to treatment
compliance, patient acceptability and subsequent treatment outcomes.

Publication Types: 
    Review

PMID: 17181386 [PubMed - indexed for MEDLINE]

329: Infection. 2006 Dec;34(6):352-4.

Coexistence of Ramsay Hunt syndrome and varicella-zoster virus encephalitis.

Kin T, Hirano M, Tonomura Y, Ueno S.

Dept. of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara
634-8522, Japan.

We describe a patient with Ramsay Hunt syndrome and varicella-zoster virus
encephalitis. The coexistence of these conditions is rare and to our knowledge
has not been clearly documented in the English-language literature. We summarize 
the clinical characteristics of our patient and seven similar patients described 
in previous reports, including those published in Japanese. Although concomitant 
diseases such as diabetes and chronic renal failure may lead to an aggressive
course, all patients described in detail have had good outcomes.

Publication Types: 
    Case Reports
    Review

PMID: 17180593 [PubMed - indexed for MEDLINE]

330: Pain Pract. 2005 Dec;5(4):327-40.

Postherpetic neuralgia: the never-ending challenge.

Niv D, Maltsman-Tseikhin A.

Center for Pain Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of
Medicine, Tel-Aviv University, Tel-Aviv, Israel. davidniv@tasmc.health.gov.il

Postherpetic neuralgia (PHN) is defined as pain that persists 1 to 3 months
following the rash of herpes zoster (HZ). PHN affects about 50% of patients over 
60 years of age and 15% of all HZ patients. Patients with PHN may experience two 
types of pain: a steady, aching, boring pain and a paroxysmal lancinating pain,
usually exacerbated by contact with the involved skin. Herpes zoster is initially
a clinical diagnosis, based on the observation of a typical dermatomal
distribution of rash and radicular pain. HZ is pathologically characterized by
inflammatory necrosis of dorsal root ganglia, occasionally associated with
evidence of neuritis, leptomeningitis, and segmental unilateral degeneration of
related motor and sensory roots. Although acyclovir has been used successfully as
standard therapy for varicella zoster virus (VZV) infection in the past decade,
resistant strains of VZV are often recognized in immunocompromised patients.
Therapy with acyclovir and the use of corticosteroids have been reported to
prevent PHN in up to 60% of HZ patients. Management of chronic pain in PHN is
more problematic. The only therapy proven effective for PHN in controlled study
is the use of tricyclic antidepressants, including amitriptyline and desipramine.
There is good evidence of efficacy from randomized trials that gabapentin and
pregabalin (new anticonvulsant drugs) are of benefit in the reduction of pain
from PHN. As alternative therapies, topical agents such as capsaicin, lidocaine
or opioid analgesic treatment may give satisfactory results. Interventions with
low risk, such as transcutaneous electrical nerve stimulation (TENS), are
appropriate. Evidence is scant for the value of surgical and procedural
interventions in general, although there are numerous, small studies supporting
the use of specific interventions such as nerve blocks, neurosurgical procedures,
and neuroaugmentation. Although antiviral agents are appropriate for acute HZ,
and the use of neural blockade and sympathetic blockade may be helpful in
reducing pain in selected patients with HZ, there is little evidence that these
interventions will reduce the likelihood of developing PHN. Postherpetic
neuralgia remains a difficult pain problem. This review describes the
epidemiology and pathophysiology of PHN and discusses proposed mechanisms of pain
generation with emphasis on the various pharmacological treatments and invasive
modalities currently available.

PMID: 17177766 [PubMed]

331: J Med Virol. 2007 Feb;79(2):192-9.

Increased prevalence of varicella zoster virus DNA in cerebrospinal fluid from
patients with multiple sclerosis.

Mancuso R, Delbue S, Borghi E, Pagani E, Calvo MG, Caputo D, Granieri E, Ferrante
P.

Laboratory of Molecular Medicine and Biotechnology, Don C. Gnocchi Foundation,
IRCCS, Milan, Italy.

In order to investigate the possible involvement of viruses in Multiple Sclerosis
(MS), the study evaluated the presence of viral genomic sequences in
cerebrospinal fluid (CSF), as markers of viral replication within the central
nervous system (CNS). A total of 85 CSF samples were collected from 38 MS
patients, 28 patients with other neurological diseases and 19 subjects without
neurological diseases. Using nested-PCR, the investigation focused on the
presence of human herpes virus DNA, including herpes simplex virus 1 (HSV-1) and 
2 (HSV-2), the Epstein-Barr virus (EBV), varicella zoster virus (VZV), human
cytomegalovirus (HCMV), human herpes virus 6 (HHV-6) and JC virus (JCV). All the 
CSF samples from the individuals without neurological diseases were negative for 
viral DNA. Genomic sequences of HSV-1, HCMV, EBV, HHV6, and JCV were found in
patients with MS and other neurological diseases without significant differences 
between the two groups. VZV DNA was detected more frequently (P < 0.05) in the MS
group (31.6%), particularly among the relapsing-remitting MS patients (43.5%),
compared with patients with other neurological diseases (10.7%). In addition, the
results indicated that JCV and HHV-6 were replicating actively in the CNS of a
small, but significant number of patients with MS and other neurological
diseases. Most importantly, the study revealed a high frequency of VZV DNA in the
CSF of patients with MS, suggesting a possible role of this virus in the
pathogenesis of MS.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17177306 [PubMed - indexed for MEDLINE]

332: Mayo Clin Health Lett. 2006 Oct;24(10):8.

My granddaughter was recently visiting and she had chickenpox. I've already had
chickenpox, but I'm concerned about getting shingles because I know the two
diseases are related. Can I catch shingles from her?

[No authors listed]

PMID: 17176523 [PubMed - indexed for MEDLINE]

333: Intervirology. 2007;50(1):40-4. Epub 2006 Nov 24.

Analysis of repeat units in the R2 region among different Oka varicella-zoster
virus vaccine strains and wild-type strains in Germany.

Sauerbrei A, Zell R, Wutzler P.

Institute of Virology and Antiviral Therapy, Friedrich Schiller University of
Jena, Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de

OBJECTIVE: The present study compared the number of R2 repeat units in six
different Oka strains and in 54 varicella-zoster virus (VZV) wild-type strains
isolated from patients with varicella or zoster in Germany. METHODS: The R2
genomic region was characterized by polymerase chain reaction and sequencing
methods. RESULTS: Five VZV Oka vaccine strains showed a number of seven 42-bp
units and, in one, eight repeats were found. In 11 VZV wild-type strains isolated
from patients with varicella, the copy number ranged between four and eight, and 
in 43 strains from zoster a similar range between four and nine copies was
observed. About 80% of all strains showed between five and seven repeated units. 
More than one third of strains revealed seven repeats like Oka. CONCLUSIONS: The 
size of the R2 repeat region can also be different in single Oka vaccine strains.
In German VZV wild-type strains, the R2 fragment seems to be not as variable as
in Japanese wild-type strains. Copyright 2007 S. Karger AG, Basel.

PMID: 17164556 [PubMed - indexed for MEDLINE]

334: Clin Gastroenterol Hepatol. 2006 Dec;4(12):1483-90.

Comment in:
    Inflamm Bowel Dis. 2007 Sep;13(9):1178-9.

Incidence and risk factors for herpes zoster among patients with inflammatory
bowel disease.

Gupta G, Lautenbach E, Lewis JD.

Center for Clinical Epidemiology and Biostatistics, Department of Internal
Medicine, University of Pennsylvania School of Medicine, Philadelphia,
Pennsylvania 19104-6021, USA.

BACKGROUND & AIMS: An increased risk of herpes zoster in patients with
inflammatory bowel disease (IBD) is hypothesized based on altered immune
function, especially among patients receiving immunosuppressive medications.
METHODS: We performed a retrospective cohort study and a retrospective nested
case-control study using 1988-1997 data from the General Practice Research
Database. In the cohort study, 7823 Crohn's disease (CD) and 11,930 ulcerative
colitis (UC) patients were matched on age, sex, and primary care practice to
79,563 randomly selected controls without CD or UC. In the nested case-control
study, 185 CD patients with zoster and 266 UC patients with zoster were matched
on sex and year of birth to 1787 IBD patients without zoster. RESULTS: In the
cohort study, the incidence of zoster was higher in patients with CD and UC
compared with their matched controls (UC incidence rate ratio, 1.21; 95%
confidence interval [CI], 1.05-1.40; CD incidence rate ratio, 1.61; 95% CI,
1.35-1.92). In the nested case-control study, receipt of a prescription for
corticosteroids (adjusted odds ratio, 1.5; 95% CI, 1.1-2.2) or
azathioprine/6-mercaptopurine (adjusted odds ratio, 3.1; 95% CI, 1.7-5.6) were
both associated with zoster. CONCLUSIONS: Patients with IBD, especially those on 
immunosuppressive medications, are at higher risk for herpes zoster compared with
the general population. Future studies should clarify the relative risk
associated with anti-tumor necrosis factor alpha therapies and determine the use 
of the new zoster vaccine for patients with IBD.

PMID: 17162240 [PubMed - indexed for MEDLINE]

335: Biol Blood Marrow Transplant. 2006 Dec;12(12):1335-42.

Antigen-specific T-lymphocyte function after cord blood transplantation.

Cohen G, Carter SL, Weinberg KI, Masinsin B, Guinan E, Kurtzberg J, Wagner JE,
Kernan NA, Parkman R.

The EMMES Corporation, Rockville, Maryland, USA.

It has not been possible to determine the singular contribution of naive T
lymphocytes to antigen-specific immunity after hematopoietic stem cell
transplantation (HSCT), because of the confounding effects of donor-derived
antigen-specific T lymphocytes present in most hematopoietic stem cell (HSC)
products. Because umbilical cord blood contains only naive T lymphocytes, we
longitudinally evaluated the recipients of unrelated cord blood transplantation
(UCBT) for the presence of T lymphocytes with specificity for herpesviruses, to
determine the contribution of the naive T lymphocytes to antigen-specific immune 
reconstitution after HSCT. Antigen-specific T lymphocytes were detected early
after UCBT (herpes simplex virus on day 29; cytomegalovirus on day 44; varicella 
zoster virus on day 94). Overall, 66 of 153 UCBT recipients developed
antigen-specific T lymphocytes to 1 or more herpesviruses during the evaluation
period. The likelihood of developing antigen-specific T lymphocyte function was
not associated with immunophenotypic T lymphocyte reconstitution, transplant cell
dose, primary disease, or acute and chronic graft-versus-host disease. These
results indicate that naive T lymphocytes present in the HSC inoculum can
contribute to the generation of antigen-specific T-lymphocyte immunity early
after transplantation.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17162216 [PubMed - indexed for MEDLINE]

336: Eur J Paediatr Neurol. 2007 Mar;11(2):104-7. Epub 2006 Dec 11.

Anti-basal ganglia antibodies and acute movement disorder following herpes zoster
and streptococcal infections.

Basheer SN, Wadsworth LD, Bjornson BH.

Division of Neurology, British Columbia Children's Hospital and the University of
British Columbia, Vancouver, British Columbia, Canada. sn.basheer@hey.nhs.uk

Anti-basal ganglia antibodies (ABGA) have been associated with poststreptococcal 
encephalitis similar to encephalitis lethargica (EL). We report two children with
parainfectious encephalitis of similar phenotype and IgG ABGA. However, the
associated pathogens in the two cases differed; beta-hemolytic streptococcus and 
herpes zoster. ABGA may not be specific to poststreptococcal encephalitis, but
rather a surrogate marker of an inflammatory mediated movement disorder, which
may respond to immunotherapy.

Publication Types: 
    Case Reports

PMID: 17161966 [PubMed - indexed for MEDLINE]

337: Pain. 2007 Mar;128(1-2):3-5. Epub 2006 Dec 11.

Comment in:
    Pain. 2007 Jul;130(1-2):195-6.

Pain following herpes zoster: the influence of changing population
characteristics and medical developments.

Johnson RW, Rice AS.

Publication Types: 
    Editorial

PMID: 17161531 [PubMed - indexed for MEDLINE]

338: Harv Mens Health Watch. 2006 Oct;11(3):5-6.

New immunizations for adults.

[No authors listed]

PMID: 17153759 [PubMed - indexed for MEDLINE]

339: Otolaryngol Pol. 2006;60(4):611-4.

[Paresis of the vagus and accessory nerve in the course of the herpes zoster]

[Article in Polish]

Dabrowska A, Tarnowska C, Jalowinski R, Amernik K, Stankiewicz J, Grzelec H.

Katedra i Klinika otolaryngologii i Onkologii Laryngologicznej Pomorskiej AM
anna.d@wp.pl

INTRODUCTION: The cephalic zoster is a cranial neuritis, with great tendency to
diffusion along the nerves. The objective of this article is both to report a
case of cranial polineuritis due to herpes zoster infection with laryngeal
involvement and review of the relevant literature. MATERIAL AND METHODS: The case
of 57-years-old man with unilateral laryngeal mucosal eruptions and complete left
vocal paralysis is reported. Laryngeal symptoms, diagnostic criteria and
therapeutic result are described. CONCLUSION: 1. In cases of head and neck herpes
zoster, the investigations of all cranial nerves should be carried out, and the
larynx must always be examinated; 2. Co-occurrence of the neuralgic pain
(radiating especially to the ear or the occipital region) with unilateral
laryngeal palsy should raise a suspicion that herpes zoster infection may by the 
causative factor; 3. The explanation of the etiologic cause of a vocal fold
paralysis in idiopathic cases, may yield not only diagnostic, but also
therapeutic value.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17152819 [PubMed - indexed for MEDLINE]

340: Herpes. 2006 Nov;13(3):75-80.

Investigations of the pathogenesis of Varicella zoster virus infection in the
SCIDhu mouse model.

Arvin AM.

Departments of Pediatrics, and Microbiology and Immunology, Stanford University
School of Medicine, Stanford, CA 94305, USA. aarvin@stanford.edu

Varicella zoster virus (VZV) is a medically important human herpesvirus that
causes varicella, establishes latency in sensory ganglia and may reactivate to
cause herpes zoster in healthy and immunocompromised patients. Experiments in the
severe combined immunodeficiency (SCID) mouse model have provided new insights
about VZV pathogenesis. In addition, the evaluation of VZV recombinant viruses,
with targeted mutations of viral genes or their promoters in SCIDhu skin, T-cell 
and dorsal root ganglia xenografts, has the potential to identify options for the
design of a recombinant 'second-generation' VZV vaccine. This would be
characterized by the retention of infectivity in skin combined with a restricted 
tropism for T-cells and neurons within sensory ganglia.

Publication Types: 
    Review

PMID: 17147912 [PubMed - indexed for MEDLINE]

341: Herpes. 2006 Nov;13(3):59.

Varicella Pathogenesis: from Hox to Mutated gE glycoproteins.

Grose C.

Publication Types: 
    Editorial
    Research Support, Non-U.S. Gov't

PMID: 17147909 [PubMed - indexed for MEDLINE]

342: Herpes. 2006 Nov;13(3):60-5.

Prevention of VZV infection in immunosuppressed patients using antiviral agents.

Boeckh M.

Fred Hutchinson Cancer Research Center, Program in Infectious Diseases,
University of Washington, Seattle, WA 98109, USA. mboeckh@fhcrc.org

Antiviral agents play a key role in the prevention and treatment of varicella
zoster virus (VZV) disease in immunosuppressed patients. Randomized trials show
that aciclovir is effective in preventing VZV reactivation disease; however, no
consensus exists on dose, duration and patient population for its use. The recent
shortage of VZV-specific immunoglobulin has generated renewed interest in the use
of antiviral agents as post-exposure prophylaxis. The use of antiviral agents for
post-exposure prophylaxis is not supported by randomized trials, but uncontrolled
experience suggests that it might be a reasonable alternative if
varicella-specific immunoglobulin is not available. Current evidence on the use
of antiviral agents in the prevention of reactivation disease and management of
exposure to VZV is discussed.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17147908 [PubMed - indexed for MEDLINE]

343: Clin Infect Dis. 2007 Jan 1;44 Suppl 1:S1-26.

Recommendations for the management of herpes zoster.

Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF,
Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN,
Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK,
van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ.

Department of Anesthesiology, University of Rochester School of Medicine and
Dentistry, Rochester, NY, 14642, USA. robert_dworkin@urmc.rochester.edu.

The objective of this article is to provide evidence-based recommendations for
the management of patients with herpes zoster (HZ) that take into account
clinical efficacy, adverse effects, impact on quality of life, and costs of
treatment. Systematic literature reviews, published randomized clinical trials,
existing guidelines, and the authors' clinical and research experience relevant
to the management of patients with HZ were reviewed at a consensus meeting. The
results of controlled trials and the clinical experience of the authors support
the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir
as first-line antiviral therapy for the treatment of patients with HZ. Specific
recommendations for the use of these medications are provided. In addition,
suggestions are made for treatments that, when used in combination with antiviral
therapy, may further reduce pain and other complications of HZ.

Publication Types: 
    Practice Guideline
    Research Support, Non-U.S. Gov't
    Review

PMID: 17143845 [PubMed - indexed for MEDLINE]

344: J Clin Pathol. 2006 Dec;59(12):1331-3.

Herpetiform cutaneous metastases from transitional cell carcinoma of the urinary 
bladder: immunohistochemical analysis.

Somani BK, Prita D, Grant S, Nabi G, N'dow J.

Department of Urology, Aberdeen Royal Infirmary Hospital, Aberdeen, Scotland, UK.

The case of an 83-year-old woman with an uncommon presentation of cutaneous
metastases from muscle-invasive transitional cell carcinoma of the urinary
bladder is reported. The band-like eruption of the metastatic lesion can often be
misdiagnosed and treated initially as herpes zoster. A detailed
immunohistochemical analysis is also described to differentiate metastatic
lesions from other sources.

Publication Types: 
    Case Reports

PMID: 17142578 [PubMed - indexed for MEDLINE]

345: Arch Phys Med Rehabil. 2006 Dec;87(12):1653-5.

Monoparesis with complex regional pain syndrome-like symptoms due to brachial
plexopathy caused by the varicella zoster virus: a case report.

Eyigor S, Durmaz B, Karapolat H.

Department of Physical Medicine and Rehabilitation, University of Ege, Medical
Faculty, Bornova, Izmir, Turkey. eyigor@hotmail.com

Viral invasion of the motoneurons and the subsequent inflammation in the anterior
horn cells by the varicella zoster virus results in a weakness in the area of the
cutaneous eruption. The exact mechanism of zoster paresis is uncertain. The
occurrence of symptoms resembling complex regional pain syndrome (CRPS) is common
in subjects where the herpes zoster (HZ) outbreak affects an extremity,
particularly if it is the distal extremity that is involved. We report the case
of a 54-year-old man with monoparesis, hyperalgesia, allodynia, edema, and both
color and skin-temperature changes in his left arm after a skin eruption.
Electrophysiologic examination revealed the partial degeneration of the superior,
middle, and inferior truncus in the brachial plexus, with evidence of HZ
infection. Magnetic resonance imaging of the cervical spine and brachial plexus
showed degenerative changes without any evidence of nerve root compression.
Brachial plexopathy may be the direct cause of the reversible upper-limb paresis 
resulting from HZ with CRPS-like symptoms.

Publication Types: 
    Case Reports

PMID: 17141648 [PubMed - indexed for MEDLINE]

346: Magn Reson Med Sci. 2006 Oct;5(3):151-5.

Prompt contrast enhancement of cerebrospinal fluid space in the fundus of the
internal auditory canal: observations in patients with meningeal diseases on
3D-FLAIR images at 3 Tesla.

Naganawa S, Sugiura M, Kawamura M, Fukatsu H, Nakashima T, Maruyama K.

Department of Radiology, Nagoya University Graduate School of Medicine, Japan.
naganawa@med.nagoya-u.ac.jp

We speculated that meningeal pathologies might facilitate the permeability of
cranial nerves at the fundus of the internal auditory canal (IAC), causing prompt
enhancement after administration of Gd-DTPA. Using a 3D- fluid-attenuated
inversion recovery (FLAIR) sequence, we evaluated the enhancement of the
cerebrospinal fluid (CSF) space in the IAC fundus 10 min after Gd-DTPA
administration in patients with meningeal diseases. Twenty patients (aged 22 to
79 years) were divided into 2 groups, a group with meningeal disease comprising 9
patients with meningeal abnormalities (6, tumor dissemination; 3, infection) and 
a control group of 11 patients with unilateral IAC pathology whose healthy sides 
were included as controls. Six of the 9 patients in the group with meningeal
disease showed bilateral enhancement; one showed unilateral enhancement. None of 
the control group showed enhancement in the healthy side. One patient with
Ramsay-Hunt syndrome showed only ipsilateral enhancement. Enhancement in the IAC 
fundus was frequently observed in patients with meningeal disease, even just 10
min after administration of contrast agent. This enhancement in the IAC fundus
was never visible on T1-weighted 3D-FLASH images.

Publication Types: 
    Evaluation Studies

PMID: 17139141 [PubMed - indexed for MEDLINE]

347: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):e37-9.
Epub 2006 Oct 2.

Ramsay-Hunt syndrome with vesicular stomatitis in a 4-year-old infant.

Koga C, Iwamoto O, Aoki M, Nakamura C, Kusukawa J, Matsuishi T.

Kurume University School of Medicine, Kurume, Japan. ckoga@med.kurume-u.ac.jp
<ckoga@med.kurume-u.ac.jp>

Ramsay-Hunt syndrome (RHS) usually affects adults, but rare cases of preschool
children with RHS have been reported. We report a case of RHS in a healthy
4-year-old girl. At the age of 4 years and 5 months, she complained of pain in
her mouth and herpes zoster vesicles were noted on the left soft palate and
tongue without left pinna, and complete left facial paralysis subsequently
developed. She was treated with acyclovir and steroids. Six months later, her
facial paralysis had almost fully resolved.

Publication Types: 
    Case Reports

PMID: 17138164 [PubMed - indexed for MEDLINE]

348: Clin Exp Dermatol. 2007 Mar;32(2):162-4. Epub 2006 Nov 27.

Complete ophthalmoplegia after herpes zoster.

Im M, Kim BJ, Seo YJ, Park JK, Lee JH.

Department of Dermatology, College of Medicine, Chungnam National University,
Daejeon, Korea.

Motor loss caused by herpes zoster is infrequent, and only a few studies have
focused on ocular motor paralysis in ophthalmic herpes zoster. We report a case
of complete ophthalmoplegia resulting from ophthalmic herpes zoster. A
69-year-old man presented with complete left-side ptosis with total
ophthalmoplegia 7 days after the onset of left ophthalmic herpes zoster. The
patient was treated with aciclovir and prednisolone. Five months later, the
ptosis had resolved and the extraocular motility had almost returned to normal.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 17137485 [PubMed - indexed for MEDLINE]

349: J Clin Microbiol. 2007 Feb;45(2):559-63. Epub 2006 Nov 29.

Toward universal varicella-zoster virus (VZV) genotyping: diversity of VZV
strains from France and Spain.

Loparev V, Martro E, Rubtcova E, Rodrigo C, Piette JC, Caumes E, Vernant JP,
Schmid DS, Fillet AM.

Biotechnology Core Facility, Coordinating Center for Infectious Diseases, Centers
for Disease Control and Prevention, Atlanta, GA 30333, USA.

Thirty-one isolates from France and Spain were genotyped using a published method
analyzing DNA sequence variation in open reading frame (ORF) 22, together with an
evaluation of three well-characterized single nucleotide polymorphisms (SNP) in
ORF 38, 54, and 62. Nineteen were allocated to the European (E) genotype, six
were mosaic-1 (M1), and two were mosaic-2 (M2). Four strains were assigned to a
new genotype, mosaic-4 (M4). All isolates were wild type, with no Oka
vaccine-associated markers. No isolates of the mosaic-3 (M3) or Japanese (J)
genotype were observed. We also evaluated 13 selected isolates of E, J, M1, and
M2 strains (9 of the 31 described above) using an alternative genotyping method
based on the assessment of multiple SNP located in ORF 1, 9, 10, 21, 31, 50, 54, 
62, and 68. This method assigns wild-type varicella-zoster virus (VZV) strains to
seven genotypes: A1, A2, J1, B1, B2, C, and C1. VZV isolates identified as E
(ORF22 method) had the genetic signature of genotype C VZV strains, M1 strains
were A1, and M2 were A2. No J strains were detected, but parental Oka and vaccine
Oka (genotype J) corresponded to genotype J1. M4 isolates (B) share the SNP array
observed for M1 and E viruses, and probably represent recombinants between
African-Asian (M1) and European (E) viruses. The two genotyping methods, using
entirely different genomic targets, produced identical clusters for the strains
examined, suggesting robust phylogenetic linkages among VZV strains circulating
in Europe.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 17135433 [PubMed - indexed for MEDLINE]

350: J Virol Methods. 2007 Feb;139(2):227-9. Epub 2006 Nov 28.

Different real-time PCR assays could lead to a different result of detection of
varicella-zoster virus in facial palsy.

Yamakawa K, Hamada M, Takeda T.

Department of Otolaryngology, Kochi Medical School, Kohasu, Oko-chou, Kochi
783-8505, Japan. yamakawk@med.kochi-u.ac.jp

Real-time PCR is a useful tool for rapid detection of viral genomic DNA. However,
there are many types of real-time PCR, and this variation may induce different
results. The sensitivity of two different real-time PCR assays was evaluated for 
the detection of the varicella-zoster virus (VZV) genome: LightCycler PCR and
TaqMan PCR. Auricular skin cells and saliva were sampled from 201 patients with
facial nerve paralysis. A hundred and seventy-one of these patients were
diagnosed clinically with Bell's palsy, and the remaining 30 with Ramsay Hunt
syndrome. In 30 specimens obtained from Ramsay Hunt syndrome patients, VZV DNA
was detected in 26 skin and 3 saliva specimens using the LightCycler PCR, while
28 skin and 9 saliva specimens were positive using the TaqMan PCR. None of the
patients with Bell's palsy were positive for VZV by the LightCycler PCR, whereas 
five of these patients were positive by the TaqMan PCR. The TaqMan PCR assay has 
a better sensitivity compared to the LightCycler PCR for the detection of VZV
genome from patients with facial palsy. Further study is required to develop a
more sensitive real-time PCR.

PMID: 17134766 [PubMed - indexed for MEDLINE]

351: Ann Hematol. 2007 Apr;86(4):301-2. Epub 2006 Nov 25.

Late onset of bortezomib-associated cutaneous reaction following herpes zoster.

Varettoni M, Vassallo C, Borroni G, Mangiacavalli S, Zappasodi P, Rosso R,
Lazzarino M, Corso A.

Publication Types: 
    Case Reports
    Letter

PMID: 17131123 [PubMed - indexed for MEDLINE]

352: Eur Arch Otorhinolaryngol. 2007 May;264(5):505-7. Epub 2006 Nov 24.

Herpes zoster laryngitis: case report and serological profile.

Watelet JB, Evrard AS, Lawson G, Bonte K, Remacle M, Van Cauwenberge P,
Vermeersch H.

Department of Otorhinolaryngology and Head & Neck Surgery, Ghent University
Hospital, Ghent, Belgium. jeanbaptiste.watelet@ugent.be

Compared to herpes zoster oticus, varicella zoster virus (VZV) reactivations in
immunocompetent patients are rare in laryngeal region. Usually, associated vocal 
cord paralyses are reported. Herein is a case report of a patient with laryngeal 
zoster without any associated motor disorders. An attempt is made to assign the
distribution of mucosal eruptions to the appropriate neuroanatomical structures. 
A description of the serological course of VZV IgM and IgG are provided. Vesicles
were found on the left sensory distribution areas of the superior laryngeal
nerve. VZV IgM and IgG antibodies reached their peak 1 month after initial
symptoms. Attentive follow-up and no antiviral therapy were advocated because of 
the absence of any immune deficiency or endoscopic suspicion of malignancy. In
this case of VZV reactivation in the sensitive area of the superior laryngeal
nerve, serological profiles of VZV IgM and IgG were profoundly modified up to the
fourth month.

Publication Types: 
    Case Reports

PMID: 17124598 [PubMed - indexed for MEDLINE]

353: Ophthalmology. 2007 Feb;114(2):307-12. Epub 2006 Nov 21.

Comment in:
    Ophthalmology. 2007 Dec;114(12):2367; author reply 2367-8.

Treatment of acute retinal necrosis syndrome with oral antiviral medications.

Aizman A, Johnson MW, Elner SG.

W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences,
University of Michigan School of Medicine, Ann Arbor, Michigan 48105, USA.

OBJECTIVE: Acute retinal necrosis (ARN) is a distinct ocular viral syndrome
traditionally treated with intravenous acyclovir followed by oral acyclovir. We
investigated the use of the oral antiviral medications valacyclovir and
famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome.
DESIGN: Retrospective, uncontrolled, interventional case series. PARTICIPANTS:
Eight consecutive patients with newly diagnosed ARN treated solely with oral
antiviral medications. INTERVENTION: All patients received famciclovir or
valacyclovir without antecedent intravenous therapy. One patient with bilateral
ARN treated with famciclovir received a single intravitreal injection of
foscarnet in the more severely involved eye. MAIN OUTCOME MEASURES: Clinically
and photographically documented complete resolution of retinitis and
best-corrected visual acuity on final follow-up. RESULTS: Active retinitis
resolved completely in 10/10 (100%) affected eyes. Initial response to treatment 
was seen as early as 4 days (in 5 eyes), with a median time to complete
resolution of 14 days. At the last examination, visual acuity was improved (> or 
= 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) 
eyes. Over a mean follow-up of 36 weeks (range, 7-72 weeks), 3 eyes developed
rhegmatogenous retinal detachment that was successfully repaired with 1
vitrectomy surgery. No patient with initially unilateral involvement developed
disease in the contralateral eye. CONCLUSIONS: In this pilot study, the use of
the oral drugs valacyclovir and famciclovir resulted in complete regression of
herpetic necrotizing retinitis. Additional studies are necessary to evaluate the 
role of these antiherpetic medications in the treatment of the ARN syndrome.

Publication Types: 
    Case Reports

PMID: 17123607 [PubMed - indexed for MEDLINE]

354: Cephalalgia. 2006 Dec;26(12):1483-4.

Secondary intermedius neuralgia-like pain in a young child.

da Silva HM, Boullosa JL, Arruda MA.

Instituto de Neurologia e Cefaleia, Rua Casemiro de Abreu 544, Ribeirao Preto,
CEP 14030-060 Sao Paulo, RP, Brazil.

Publication Types: 
    Case Reports

PMID: 17116099 [PubMed - indexed for MEDLINE]

355: Headache. 2006 Nov-Dec;46(10):1590-1.

Occipital neuralgia evoked by facial herpes zoster infection.

Kihara T, Shimohama S.

Department of Neuroscience for Drug Discovery, Graduate School of Pharmaceutical 
Sciences, Kyoto University, Yoshida-Shimoadachi-cho 46-29, Sakyo-ku, Kyoto
606-8501, Japan.

Occipital neuralgia is a pain syndrome which may usually be induced by spasms of 
the cervical muscles or trauma to the greater or lesser occipital nerves. We
report a patient with occipital neuralgia followed by facial herpes lesion. A
74-year-old male experienced sudden-onset severe headache in the occipital area. 
The pain was localized to the distribution of the right side of the greater
occipital nerve, and palpation of the right greater occipital nerve reproduces
the pain. He was diagnosed with occipital neuralgia according to ICHD-II
criteria. A few days later, the occipital pain was followed by reddening of the
skin and the appearance, of varying size, of vesicles on the right side of his
face (the maxillary nerve and the mandibular nerve region). This was diagnosed as
herpes zoster. This case represents a combination of facial herpes lesions and
pain in the C2 and C3 regions. The pain syndromes can be confusing, and the
classic herpes zoster infection should be considered even when no skin lesions
are established.

Publication Types: 
    Case Reports

PMID: 17115995 [PubMed - indexed for MEDLINE]

356: Arch Virol. 2007;152(3):553-63. Epub 2006 Nov 20.

Simian varicella virus gene 61 encodes a viral transactivator but is
non-essential for in vitro replication.

Gray WL, Davis K, Ou Y, Ashburn C, Ward TM.

Department of Microbiology and Immunology, University of Arkansas for Medical
Sciences, Little Rock, AR 72205, USA. graywaynel@uams.edu

Simian varicella virus (SVV) is closely related to varicella-zoster virus (VZV), 
the causative agent of chickenpox and shingles. The SVV and VZV gene 61
polypeptides are homologs of the HSV-1 ICP0, a viral transactivator which appears
to play a role in viral latency and reactivation. In this study, the molecular
properties of the SVV 61 were characterized. The SVV open reading frame (ORF) 61 
encodes a 54.1-kDa polypeptide with 37% amino acid identity to the VZV 61.
Homology to the HSV-1 ICP-0 is limited to a conserved RING finger motif at the
amino terminus of the protein. A nuclear localization sequence (nls) at the
carboxy-terminus directs the SVV 61 to the cell nucleus, while a SVV 61nls(-)
mutant is confined to the cell cytoplasm. The SVV 61 transactivates its own
promoter as well as SVV immediate early (IE, ORF 62), early (ORFs 28 and 29), and
late (ORF 68) gene promoters in transfected Vero cells. The RING finger and nls
motifs are required for efficient SVV 61 transactivation. The SVV 61 has no
effect on the ability of the major SVV transactivator (IE62) to induce SVV
promoters. Generation and propagation of a SVV gene 61 deletion mutant
demonstrated that the SVV 61 is non-essential for in vitro replication. SVV gene 
61 is expressed in liver, lung, and neural ganglia of infected monkeys during
acute simian varicella.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17115302 [PubMed - indexed for MEDLINE]

357: HNO. 2008 Feb;56(2):165-8.

[Myxoma of the middle ear-a rare cause of facial palsy]

[Article in German]

Zehlicke T, Punke C, Haase K, Boltze C, Pau HW.

Universitatsklinik und Poliklinik fur Hals-, Nasen-, Ohrenheilkunde, Kopf- und
Halschirurgie Otto Korner, Doberaner Strasse 137-139, 18057 Rostock.
thorsten.zehlicke@web.de

In case of the co-occurrence of facial palsy and inflammation-like symptoms of
the same ear, the differential diagnosis is focused on viral (herpes zoster) or
bacterial diseases. We report a patient for whom the surgical exploration of the 
middle ear revealed a benign tumor: a myxoma. These neoplasias are rare tumors in
the head and neck region. The typical tumor site is the atrium of heart. In the
ear, the tumor grows slowly and remains asymptomatic unless it irritates
structures such as the facial nerve or the vestibular organ. Histologically, the 
tumor presents a "myxoid" matrix that is rich in acid mucopolysaccarides. The
treatment of choice is complete surgical resection. Using the case presented, we 
discuss the causality between the tumor and the facial palsy, although during the
operation the bony canal of the nerve was found to be intact. In any cases with
clinically and radiologically unclear findings of the ear in connection with
facial palsy, surgical exposure should be considered.

Publication Types: 
    English Abstract

PMID: 17115088 [PubMed - in process]

358: J Pediatr Hematol Oncol. 2006 Nov;28(11):757-9.

Concomitant Candida epiglottitis and disseminated Varicella zoster virus
infection associated with acute lymphoblastic leukemia.

Chiou CC, Seibel NL, Derito FA, Bulas D, Walsh TJ, Groll AH.

Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer
Institute, Bethesda, MD 20892, USA.

Acute epiglottitis by nonbacterial pathogens is an uncommon but life-threatening 
clinical entity. Herein, we report the concomitant occurrence of Candida
epiglottitis and mucosal and visceral Varicella zoster virus infection in a child
with acute lymphoblastic leukemia. Both infections were atypical in their
presentation, occurred in a severely immunocompromised host, and required
invasive procedures for diagnosis.

Publication Types: 
    Case Reports

PMID: 17114965 [PubMed - indexed for MEDLINE]

359: Med Hypotheses. 2007;68(5):1059-64. Epub 2006 Nov 17.

Alzheimer's disease Braak Stage progressions: reexamined and redefined as
Borrelia infection transmission through neural circuits.

MacDonald AB.

St. Catherine of Siena Medical Center, Department of Pathology, 50 Rte 25 A,
Smithtown, NY 11787, USA. inmacdonald@yahoo.com

Brain structure in health is a dynamic energized equation incorporating
chemistry, neuronal structure, and circuitry components. The chemistry "piece" is
represented by multiple neurotransmitters such as Acetylcholine, Serotonin, and
Dopamine. The neuronal structure "piece" incorporates synapses and their
connections. And finally circuits of neurons establish "architectural blueprints"
of anatomic wiring diagrams of the higher order of brain neuron organizations. In
Alzheimer's disease, there are progressive losses in all of these components.
Brain structure crumbles. The deterioration in Alzheimer's is ordered,
reproducible, and stepwise. Drs. Braak and Braak have described stages in the
Alzheimer disease continuum. "Progressions" through Braak Stages benchmark
"Regressions" in Cognitive function. Under the microscope, the Stages of Braak
commence in brain regions near to the hippocampus, and over time, like a tsunami 
wave of destruction, overturn healthy brain regions, with neurofibrillary tangle 
damaged neurons "marching" through the temporal lobe, neocortex and occipital
cortex. In effect the destruction ascends from the limbic regions to
progressively destroy the higher brain centers. Rabies infection also "begins low
and finishes high" in its wave of destruction of brain tissue. Herpes Zoster
infections offer the paradigm of clinical latency of infection inside of nerves
before the "marching commences". Varicella Zoster virus enters neurons in the
pediatric years. Dormant virus remains inside the neurons for 50-80 years, tissue
damage late in life (shingles) demonstrates the "march of the infection" down
neural pathways (dermatomes) as linear areas of painful blisters loaded with
virus from a childhood infection. Amalgamation of Zoster with Rabies models
produces a hybrid model to explain all of the Braak Stages of Alzheimer's disease
under a new paradigm, namely "Alzheimer's neuroborreliosis" in which latent
Borrelia infections ascend neural circuits through the hippocampus to the higher 
brain centers, creating a trail of neurofibrillary tangle injured neurons in
neural circuits of cholinergic neurons by transsynaptic transmission of infection
from nerve to nerve.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17113237 [PubMed - indexed for MEDLINE]

360: J Can Dent Assoc. 2006 Nov;72(9):829-32.

Unilateral facial swelling caused by Ramsay Hunt syndrome resembles odontogenic
infection.

Jan AM, McGuire TP, Clokie CM, Sandor GK.

Division of oral and maxillofacial surgery, University of Toronto, Toronto,
Ontario, Canada.

Facial cellulitis and swellings of the head and neck are worrisome signs of
odontogenic infection, which can be life threatening. Most head and neck
infections are caused by bacterial pathogens. When treating such infections,
dentists must also be aware of possible viral or fungal causes and their
associated presentations. This report documents a case of viral infection that
initially resembled a bacterial odontogenic infection. It is intended to
familiarize dentists with the Ramsay Hunt syndrome and the need for prompt
recognition and early definitive treatment.

Publication Types: 
    Case Reports

PMID: 17109804 [PubMed - indexed for MEDLINE]

361: Dev Med Child Neurol. 2006 Dec;48(12):991-3.

Recurrent hemiplegia associated with cerebral vasculopathy following third
trimester maternal herpes zoster infection.

West SL, Newton RW, Baildam EM, Turner AJ, Arkwright PD.

Royal Manchester Children's Hospital, Manchester, UK.
Siobhan.wykes@doctors.org.uk

The chickenpox virus (varicella zoster virus; VZV) is known to cause large and
small vessel central nervous system vasculopathies that may be associated with
strokes in both adults and children. We present the case of a female aged 2 years
6 months who developed a chronic progressive small-vessel vasculopathy with
radiological features of moyamoya disease as a manifestation of congenital
varicella syndrome. Clinically, the condition was characterized by recurrent
ischaemic strokes, which were brought under control using intravenous acyclovir. 
The case is unique in that it is the first report of congenital varicella
syndrome to occur after a maternal herpes zoster infection. Furthermore, it is
the first case of symptomatic VZV infection in a child to occur after a maternal 
infection occurring in the third trimester of pregnancy.

Publication Types: 
    Case Reports

PMID: 17109789 [PubMed - indexed for MEDLINE]

362: J Int Assoc Physicians AIDS Care (Chic Ill). 2006 Dec;5(4):157-60.

Immune reconstitution syndrome presenting with cerebral varicella zoster
vasculitis in HIV-1-infected patient: a case report.

Patel AK, Patel KK, Shah SD, Desai J.

Infectious Diseases Clinic, Ahmedabad, India. atulpatel65@gmail.com

Neurologic dysfunction complicating HIV infection may occur in up to 70% of AIDS 
patients. The advent of highly active antiretroviral therapy has reduced central 
nervous system opportunistic infections. Immune reconstitutions after highly
active antiretroviral therapy also lead to atypical presentations of neurologic
opportunistic infections. We report a man who developed an encephalitic illness
10 months after institution of highly active antiretroviral therapy and
improvement in his CD4 count. Varicella zoster vasculitis involving the brain was
suspected. Acyclovir therapy resulted in complete clinical and radiologic
recovery. Symptomatic reactivation of varicella zoster infection within the
encephalon during therapeutic immunologic reconstitution is rare and should be
suspected, especially in patients with neurologic syndrome consistent with
encephalitis with recent history of herpes zoster and multiple, discrete areas of
infarct or demyelination on brain magnetic resonance imaging. The clinical and
neuroradiologic features of this condition and its relevance to the immune
reconstitution syndrome are discussed.

Publication Types: 
    Case Reports

PMID: 17101808 [PubMed - indexed for MEDLINE]

363: Transplant Proc. 2006 Oct;38(8):2416-8.

Varicella infection in adult renal allograft recipients: experience at one
center.

Rodriguez-Moreno A, Sanchez-Fructuoso AI, Calvo N, Ridao N, Conesa J, Marques M, 
Prats D, Barrientos A.

Department of Nephrology, Hospital Clinico San Carlos, Madrid, Spain.
arodriguez@friat.es

Disseminated varicella-zoster virus (VZV) infection in adult renal allograft
recipients is a rare but potentially fatal illness. We retrospectively collected 
the cases of VZV infection that occurred in 812 adult renal transplant
recipients, performed between 1995 and 2004 at our institution. Eight patients
developed varicella (1%), seven men and one woman. The overall median age was 38 
years (range = 31 to 64). The median time from transplantation to infection was
32 months (range = 2 to 92). Four cases were primary infections and four
disseminated VZV reactivations. Immunosuppression consisted of prednisone (PDN) +
cyclosporine (CSA) + mycophenolate (MF; n = 4); PDN + CSA + azathioprine (n = 1);
PDN + tacrolimus (FK) + MF (n = 1); FK + MF (n = 1); PDN + rapamycin + MF (n =
1). Seven patients (87%) required hospital admission for a median duration of 11 
days (range = 3 to 21). Four patients were previously diagnosed with chronic
hepatitis virus infection: two type B (HBV) and two type C (HCV). The last cohort
required longer admission than the negative patients (11.5 +/- 3 vs 7.5 +/- 9
days; P = .1). The only clinical manifestation in four patients was general
malaise, fever, and a disseminated vesicular rash; the other four patients also
showed visceral involvement: two pneumonitis, one hepatitis, and thrombotic
microangiopathy, and one developed multiorgan failure and died due to a delayed
diagnosis in a patient positive for HBVs. The diagnosis was established according
to the symptoms, IgG-IgM seroconversion and VZV polymerase chain reaction
quantification in vesicle contents. Treatment consisted of reduced
immunosuppression, antiviral drugs (acyclovir or gancyclovir), and in six
patients, a varicella-zoster immunoglobulin dose. We concluded that varicella
infection in adult renal allograft recipients is unusual but highly morbid. A
vaccination program in seronegative pretransplant candidates should be attempted.
Early diagnosis and treatment may improve the prognosis. Although further studies
are required, chronic HBV or HCV infection seemed to be a risk factor for the
disease.

PMID: 17097954 [PubMed - indexed for MEDLINE]

364: An Otorrinolaringol Ibero Am. 2006;33(5):489-94.

[Ramsay-Hunt syndrome associated to unilateral recurrential paralysis]

[Article in Spanish]

Pino Rivero V, Gonzalez Palomino A, Pantoja Hernandez CG, Mora Santos ME,
Trinidad Ramos G, Blasco Huelva A.

Complejo Hospitalario Infanta Cristina, Facultativo Especialista de
Otorrinolaringologia, Badajoz. vicentepinorivero@terra.com

Varicella herpes zoster (VZV) virus reactivaction can produce multiple
neuropathies of the cranial and cervical region being the peripheral facial
paralysys the most common one. We report one case of Ramsay-Hunt syndrome with
eruption of vesicles on left auricular pinna and face besides facial palsy which 
associated to ipsilateral laryngeal or recurrential paralysis nonexisting
previously. Our patient was treated by oral aciclovir (800 mg, 5 times daily) for
1 week. 3 months later she returned to Emergencies due to another cause and the
ENT exploration showed a recovery in the mobility of the left cord but it
persisted the affectation of VII pair, specially the inferior branch or
cervicofacial. It is advised that the larynx should be examined in all cases of
herpes zoster that involve the head and neck.

Publication Types: 
    Case Reports
    English Abstract

PMID: 17091862 [PubMed - indexed for MEDLINE]

365: J Burn Care Res. 2006 Nov-Dec;27(6):914-6.

Misdiagnosis of burns: herpes zoster ophthalmicus.

Sawyer AR, Williams G.

Burns Unit, Chelsea and Westminster Hospital, London, United Kingdom.

Many conditions can mimic the presentation of burns. We present an interesting
case in which the initial diagnosis of a chemical burn was later confirmed to be 
herpes zoster ophthalmicus.

Publication Types: 
    Case Reports

PMID: 17091093 [PubMed - indexed for MEDLINE]

366: Biol Blood Marrow Transplant. 2006 Oct;12(10):1096-7.

Postexposure prophylaxis against varicella zoster virus infection among
hematopoietic stem cell transplant recipients.

Weinstock DM, Boeckh M, Sepkowitz KA.

Publication Types: 
    Letter

PMID: 17084374 [PubMed - indexed for MEDLINE]

367: Cornea. 2006 Jul;25(6):742-4.

"Steel wool keratopathy": a clinical sign of chronic inflammation.

Seitzman GD, Strauss EC, Margolis TP.

Francis I Proctor Foundation and Department of Ophthalmology, University of
California San Francisco, San Francisco, CA, USA.

PURPOSE: To introduce into the clinical nomenclature a sign frequently observed
in our patients with persistent corneal inflammation associated with herpetic
stromal keratitis. METHODS: Case reports and review of the literature. RESULTS:
Four representative patients with herpesvirus stromal keratitis are presented.
Herpes simplex virus-1 (HSV-1) was confirmed by culture in 1 case and by
polymerase chain reaction in a second case. In the remaining 2 cases, the
diagnosis was made based on characteristic clinical findings for herpes simplex
virus and varicella zoster virus (VZV). On clinical examination, all 4
representative cases of stromal keratitis revealed a well-defined, localized
region of intertwined, metallic-like, polychromatic material in the corneal
stroma, a sign we have termed steel wool keratopathy. We have only rarely
observed this finding in patients with stromal keratitis not caused by a
herpesvirus. CONCLUSION: Steel wool keratopathy seems to represent a focal region
of stromal degeneration or deposition associated with chronic inflammation.
Although we most often observe this finding in patients with stromal keratitis
secondary to HSV or VZV, we cannot exclude the possibility that this sign
represents the sequelae of chronic/recurrent inflammation rather than a specific 
pathologic response to herpetic antigens.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17077672 [PubMed - indexed for MEDLINE]

368: Pain. 2007 Mar;128(1-2):148-56. Epub 2006 Oct 27.

Comment in:
    Pain. 2007 Mar;128(1-2):189-90; author reply 190-2.

Natural history of pain following herpes zoster.

Thyregod HG, Rowbotham MC, Peters M, Possehn J, Berro M, Petersen KL.

UCSF Pain Clinical Research Center, Department of Neurology, University of
California, San Francisco, CA 94115, USA.

In a longitudinal observational study of 94 patients (39 M:55 F, mean age 69) at 
elevated risk for developing post herpetic neuralgia (PHN), the natural history
of pain during the first 6 months after herpes zoster (HZ) rash onset was
determined. Pain severity and impact were rated using pain-VAS, SF-MPQ, and MPI. 
Applying a definition of PHN of average daily pain >0/100 on the pain VAS during 
the last 48 h, 30 subjects had PHN at 6 months. These 30 subjects reported more
pain and a higher SF-MPQ score (p<0.01) at study inclusion than the 64 subjects
whose pain completely resolved by 6 months. At 6 months, mean daily pain in the
PHN group was 11/100 (95% CI 5,16) and only nine of these subjects were still
taking prescription medication for HZ pain. The rate of recovery (pain severity
over time) was the same in the PHN and no-pain groups. At study inclusion, the
SF-MPQ and MPI scores in our PHN group were similar to historical controls with
chronic severe PHN enrolled in clinical trials, but by 6 months the scores in our
PHN subjects were significantly lower than historic controls. Only two subjects
met the more stringent criteria for 'clinically meaningful' PHN at 6 months (> or
= 30/100 on the pain VAS). Defining PHN as average daily pain >0/100 at 6 months 
after rash onset appears to substantially overestimate the number of HZ patients 
negatively impacted by ongoing pain and disability.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17070998 [PubMed - indexed for MEDLINE]

369: J Med Virol. 2006 Dec;78(12):1679-87.

The optimization and validation of the glycoprotein ELISA assay for quantitative 
varicella-zoster virus (VZV) antibody detection.

Hammond O, Wang Y, Green T, Antonello J, Kuhn R, Motley C, Stump P, Rich B,
Chirmule N, Marchese RD.

Vaccine and Biologics Research, Merck Research Laboratories, Wayne, Pennsylvania,
USA.

Varicella is a highly contagious viral disease found throughout the world. A
live-attenuated Varicella-Zoster virus (VZV) vaccine (Oka/Merck strain),
VARIVAXtrade mark, was licensed in the United States (US) in 1995 and was made a 
part of the US recommended childhood vaccination schedule in 1996. The immune
response to VZV-containing vaccines has been measured using an enzyme-linked
immunosorbent assay (ELISA) to detect antibodies to glycoproteins from VZV. A
correlate for protective immunity has been established between anti-VZV
glycoprotein antibody levels and protection against breakthrough varicella in
children, and this correlate is used as the primary immunogenicity endpoint in
clinical trials with VZV-containing vaccines. The performance of the "first
generation" validated version of the assay was recently reevaluated in order to
identify areas for improvement. Specific format and reagent changes were
implemented, with the goal of improving assay consistency by maintaining tighter 
control over assay processes and reagents. An extensive validation of the "second
generation" gpELISA was undertaken in order to characterize the updated assay. In
this article, we describe the gpELISA method, detail the procedures used to
evaluate assay performance, and present the operating characteristics of the
second generation gpELISA. (c) 2006 Wiley-Liss, Inc.

Publication Types: 
    Validation Studies

PMID: 17063506 [PubMed - indexed for MEDLINE]

370: J Laryngol Otol. 2007 Feb;121(2):163-5. Epub 2006 Oct 24.

A case of glossopharyngeal zoster diagnosed by detecting viral specific antigen
in the pharyngeal mucous membrane.

Nakagawa H, Nagasao M, Kusuyama T, Fukuda H, Ogawa K.

Department of Otolaryngology, Seibo International Catholic Hospital, Tokyo,
Japan. hnakagawa@seibokai.or.jp

Glossopharyngeal nerve paralysis caused by varicella zoster virus reactivation is
rare. We present a case of glossopharyngeal zoster confirmed by direct
immunofluorescence staining for virus antigens. A 35-year-old man presented with 
right-sided, severe swallowing pain and dysgeusia. Physical examination showed a 
loss of ipsilateral gag reflex. White spots on the posterior wall of the right
pyriform sinus were seen by laryngofibroscopy, and a loss of taste on the right
posterior part of the tongue was confirmed by gustometry using the filter paper
disc method. The varicella zoster virus antigen was revealed by direct
immunofluorescence staining by fluorescein isothiocyanate labelled mouse
monoclonal antibody specific for varicella zoster virus glycoprotein, using
samples obtained from the mucosal lesion by abrasion with a cotton swab. The
patient was treated by intravenous administration of acyclovir. His throat pain
and dysgeusia completely resolved. We discuss the advantages of direct
immunofluorescence staining for varicella zoster virus antigen for the diagnosis 
of glossopharyngeal zoster.

Publication Types: 
    Case Reports

PMID: 17059621 [PubMed - indexed for MEDLINE]

371: MMW Fortschr Med. 2006 Sep 28;148(39):48-9.

[Burning pain on one side of the body and blisters filled with clear fluid.
Tentative diagnosis: shingles]

[Article in German]

Mohrenschlager M, Ring J, Hofmann H.

Klinik und Poliklinik fur Dermatologie und Allergologie am Biederstein,
Technische Universitat Munchen. moehrenschlager@lrz.tum.de

Publication Types: 
    Case Reports

PMID: 17059198 [PubMed - indexed for MEDLINE]

372: Ocul Immunol Inflamm. 2006 Oct;14(5):317-9.

Necrotizing scleritis due to varicella zoster infection: a case report.

Gungor IU, Ariturk N, Beden U, Darka O.

Department of Ophthalmology, School of Medicine, Ondokuz Mayis University,
Samsun, Turkey. ligungor@omu.edu.tr

PURPOSE: To report a case with necrotizing scleritis due to varicella-zoster
infection. METHODS: The patient records were evaluated. The present literature
was investigated using MEDLINE. A six-year-old boy with varicella infection was
admitted to our clinic with redness, pain, and lid edema on the right eye. Slit
lamp examination revealed lid edema, purulent secretion, conjunctival injection
and chemosis, and inferotemporal scleral necrosis. Sclera was avascular and the
conjunctiva was spontaneously detached from sclera in the necrotic region.
RESULTS: Systemic and topical acyclovir treatment was started and a rapid
improvement achieved in signs and symptoms. CONCLUSIONS: Ophthalmic
manifestations of varicella infection are potentially blinding especially in the 
absence of appropriate diagnosis and medical intervention. Distinctive skin
eruptions are specifically helpful in the early diagnosis of the disease.

Publication Types: 
    Case Reports

PMID: 17056468 [PubMed - indexed for MEDLINE]

373: Cell. 2006 Oct 20;127(2):305-16.

Insulin degrading enzyme is a cellular receptor mediating varicella-zoster virus 
infection and cell-to-cell spread.

Li Q, Ali MA, Cohen JI.

Laboratory of Clinical Infectious Diseases, Medical Virology Section, National
Institutes of Health, Bethesda, MD, 20892 USA.

Varicella-zoster virus (VZV) causes chickenpox and shingles. While varicella is
likely spread as cell-free virus to susceptible hosts, the virus is transmitted
by cell-to-cell spread in the body and in vitro. Since VZV glycoprotein E (gE) is
essential for virus infection, we postulated that gE binds to a cellular
receptor. We found that insulin-degrading enzyme (IDE) interacts with gE through 
its extracellular domain. Downregulation of IDE by siRNA, or blocking of IDE with
antibody, with soluble IDE protein extracted from liver, or with bacitracin
inhibited VZV infection. Cell-to-cell spread of virus was also impaired by
blocking IDE. Transfection of cell lines impaired for VZV infection with a
plasmid expressing human IDE resulted in increased entry and enhanced infection
with cell-free and cell-associated virus. These studies indicate that IDE is a
cellular receptor for both cell-free and cell-associated VZV.

Publication Types: 
    Research Support, N.I.H., Intramural

PMID: 17055432 [PubMed - indexed for MEDLINE]

374: Auris Nasus Larynx. 2007 Jun;34(2):159-64. Epub 2006 Oct 19.

Analysis of prognostic factors in Bell's palsy and Ramsay Hunt syndrome.

Yeo SW, Lee DH, Jun BC, Chang KH, Park YS.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The
Catholic University of Korea, 505 Banpo-dong, Secho-gu, Seoul 137-701, Republic
of Korea.

OBJECTIVE: This study evaluated the prognostic factors in Bell's palsy and Ramsay
Hunt syndrome (HZO). METHODS: A retrospective, institutional review
board-approved study at a university-based hospital. A total of 81 patients
consisting of 55 Bell's palsy patients and 26 HZO patients were enrolled in this 
study. The treatment consisted uniformly in all cases, and acyclovir was
administered in the case of Ramsay Hunt syndrome. All patients were followed up
until they recovered or for least up 6 months. RESULTS: The recovery rates to
House-Brackmann grade II or better were 96.3% in those with Bell's palsy and
84.6% in those with HZO. In the HZO cases, older patients had a poorer initial
and final status, and less chance of making a complete recovery than the younger 
patients. The HZO patients without diabetes mellitus had a higher chance of
recovery, a higher chance of complete recovery, and a better final status. In
addition, HZO patients without essential hypertension had a higher degree of
recovery. HZO patients not suffering from vertigo had a higher chance of
recovery. CONCLUSION: There was no prognostic factor found in the Bell's palsy
patients in this study. The prognostic factors of HZO were age, diabetus
mellitus, essential hypertension and vertigo.

PMID: 17055202 [PubMed - indexed for MEDLINE]

375: Clin Infect Dis. 2006 Nov 15;43(10):1301-3. Epub 2006 Oct 11.

Reactivation of 2 genetically distinct varicella-zoster viruses in the same
individual.

Taha Y, Scott FT, Parker SP, Syndercombe Court D, Quinlivan ML, Breuer J.

Skin Virus Laboratory, Centre for Infectious Diseases Research, Barts and the
London School of Medicine and Dentistry, London, E1 2AT, United Kingdom.

Varicella-zoster viruses recovered from 2 episodes of herpes zoster in an
immunocompetent man were found to be different genotypes. The fact that the 2
isolates came from the same individual was confirmed by DNA fingerprinting.
Immunity following chickenpox may not always protect against systemic
reinfection. This finding raises questions about varicella-zoster virus
pathogenesis and may have an impact on public health policy.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 17051496 [PubMed - indexed for MEDLINE]

376: Vaccine. 2006 Nov 17;24(47-48):6875-85. Epub 2006 Jul 7.

Safety, tolerability, and immunogenicity of a two-dose regimen of high-titer
varicella vaccine in subjects > or =13 years of age.

Diaz C, Dentico P, Gonzalez R, Mendez RG, Cinquetti S, Barben JL, Harmon A,
Chalikonda I, Smith JG, Stek JE, Robertson A, Caulfield MJ, Biasio LR, Silber JL,
Chan CY, Vessey R, Sadoff J, Chan IS, Matthews H, Wang W, Schlienger K, Schodel
FP; Protocol 049 Study Group.

University of Puerto Rico School of Medicine, San Juan, Puerto Rico.

A new manufacturing process, known as process upgrade varicella vaccine (PUVV)
was developed for a refrigerated formulation of varicella vaccine and for an
investigational zoster vaccine. Safety and tolerability of a two-dose regimen of 
high-titered (approximately 50,000 PFU) PUVV were compared to a lower-titer
formulation (approximately 5400 PFU) of VARIVAX; in 1366 healthy subjects > or
=13 years old. Only one vaccine-related clinical serious adverse experience
(pruritus; no hospitalization) was reported, in the VARIVAX group. Injection-site
adverse experiences following any dose were higher in the PUVV group, 70.0%, than
in the VARIVAX group, 56.2%, but generally were mild. Immunogenicity were similar
in both groups in seronegative subjects. PUVV was generally well tolerated, and
elicited an immune response similar to that induced by the marketed formulation
of VARIVAX.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial

PMID: 17050042 [PubMed - indexed for MEDLINE]

377: Mayo Clin Womens Healthsource. 2006 Nov;10(11):3.

FDA approves shingles vaccine for older adults.

[No authors listed]

Publication Types: 
    News

PMID: 17047564 [PubMed - indexed for MEDLINE]

378: Lancet. 2006 Oct 14;368(9544):1365-76.

Erratum in:
    Lancet. 2007 Feb 17;369(9561):558.

Comment in:
    Lancet. 2006 Dec 23;368(9554):2208.    Lancet. 2006 Dec 23;368(9554):2208-9.

Varicella.

Heininger U, Seward JF.

Division of Paediatric Infectious Diseases and Vaccinology, University Children's
Hospital, Basel, Switzerland. Ulrich.Heininger@unibas.ch

Varicella-zoster virus, a herpesvirus, causes varicella (chickenpox) and, after
endogenous reactivation, herpes zoster (shingles). Varicella, which is recognised
by a characteristic vesicular rash, arises mainly in young children, although
older individuals can be affected. In immunocompetent patients, symptoms are
usually mild to moderate, but an uncomplicated severe case can have more than
1000 lesions and severe constitutional symptoms. Serious complications--including
central nervous system involvement, pneumonia, secondary bacterial infections,
and death--are sometimes seen. Varicella can be prevented by vaccination. Vaccine
is about 80-85% effective against all disease and highly (more than 95%)
effective in prevention of severe disease. In the USA, a routine childhood
immunisation programme has reduced disease incidence, complications, hospital
admissions, and deaths in children and in the general population, indicating
strong herd immunity. Similar immunisation programmes have been adopted by some
other countries, including Uruguay, Germany, Taiwan, Canada, and Australia, and
are expected to be implemented more widely in future.

Publication Types: 
    Review

PMID: 17046469 [PubMed - indexed for MEDLINE]

379: Nurs Older People. 2006 Oct;18(9):20-2.

Shingles: relief at last.

Dinsdale P.

PMID: 17042348 [PubMed - indexed for MEDLINE]

380: J Dermatol. 2006 Oct;33(10):705-8.

Drug eruption caused by the nonionic contrast medium iohexol. "Recall-like
phenomenon" appearing on an area previously affected by herpes zoster.

Matsumura T, Watanabe H, Batchelor J, Sueki H, Iijima M.

Department of Dermatology, Showa University School of Medicine, 1-5-8 Hatanodai, 
Shinagawa-ku, Tokyo 142-8666, Japan.

We report a case of "recall-like phenomenon" caused by nonionic contrast medium. 
A 62-year-old woman suffering from postherpetic neuralgia developed erythematous 
plaques 12 h after an intercostal nerve block under X-ray guidance using iohexol 
(Omnipaque) as contrast medium. The erythematous plaques were preferentially
located in the sites where she had experienced herpes zoster 4 months previously.
The lesions cleared spontaneously leaving no pigmentation. Both patch testing and
intradermal testing with iohexol and ioversol were positive. We postulate that
local immunological changes in the skin, such as an increased number and/or
accelerated activity of Langerhans cells and mast cells in the herpes zoster
lesions, were responsible for this phenomenon. This "recall-like phenomenon",
occurring preferentially in skin previously affected by herpes zoster, could
facilitate understanding of the pathology of drug eruptions.

Publication Types: 
    Case Reports

PMID: 17040501 [PubMed - indexed for MEDLINE]

381: J Drugs Dermatol. 2006 Oct;5(9):863-6.

A novel vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia.

Holcomb K, Weinberg JM.

Department of Dermatology, St. Luke's-Roosevelt Hospital Center and Beth Israel
Medical Center, New York, NY 10025, USA.

Varicella-zoster virus is the causal agent of varicella and herpes zoster in
humans. Herpes zoster results from reactivation of latent varicella-zoster virus 
(VZV) within the sensory ganglia. The incidence and severity of herpes zoster
increase with advancing age. More than half of all persons in whom herpes zoster 
develops are older than 60 years. The most frequent debilitating complication is 
postherpetic neuralgia, a neuropathic pain syndrome that persists or develops
after the dermatomal rash has healed and can be prolonged and disabling. There
are many limitations of current therapies for herpes zoster and postherpetic
neuralgia. A live attenuated VZV vaccine has been developed and recently approved
by the FDA for the prevention of herpes zoster in individuals 60 years of age and
older. In a randomized, double-blind, placebo-controlled trial with 38,546
patients 60 years of age or older, the use of the zoster vaccine reduced the
burden of illness due to herpes zoster by 61.1% (P < .001), reduced the incidence
of postherpetic neuralgia by 66.5% (P < .001), and reduced the incidence of
herpes zoster by 51.3% (P < .001). In this review, we will discuss the history of
the use of the varicella vaccine in children, and the subsequent development of
the new zoster vaccine.

Publication Types: 
    Review

PMID: 17039651 [PubMed - indexed for MEDLINE]

382: J Am Pharm Assoc (2003). 2006 Sep-Oct;46(5):647-9.

Shingles prevention: vaccine presents opportunity to pharmacists.

Hayney MS.

School of Pharmacy, University of Wisconsin, Madsion, USA.
mshayney@pharmacy.wisc.edu

PMID: 17036653 [PubMed - indexed for MEDLINE]

383: Paediatr Respir Rev. 2006;7 Suppl 1:S328.

CR8-194--A case of fulminated fatal disseminated Varicella Zoster virus infection
with severe pulmonary damage.

Kobayashi Y, Watanabe T, Inoue Y, Arakawa H, Mochizuki H, Tokuyama K, Morikawa A.

Gunma University Graduate School of Medicine, Pediatrics and Developmental
Medicine, Maebashi, Gunma, Japan.

Publication Types: 
    Case Reports

PMID: 17036409 [PubMed - indexed for MEDLINE]

384: J Clin Microbiol. 2006 Dec;44(12):4441-3. Epub 2006 Oct 11.

Relationship between preexisting anti-varicella-zoster virus (VZV) antibody and
clinical VZV reactivation in hematopoietic stem cell transplantation recipients.

Onozawa M, Hashino S, Takahata M, Fujisawa F, Kawamura T, Nakagawa M, Kahata K,
Kondo T, Ota S, Tanaka J, Imamura M, Asaka M.

Department of Gastroenterology and Hematology, Hokkaido University Graduate
School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
masahiro.onozawa@nifty.ne.jp

Reactivation of latent varicella-zoster virus (VZV), presenting as localized
zoster or as disseminated infection, is a common and potentially serious
complication in hematopoietic stem cell transplantation (HSCT) recipients. We
retrospectively studied anti-VZV immunoglobulin G titers by the immune adherence 
hemagglutination method after HSCT and also studied VZV DNA by real-time PCR
during clinical VZV reactivation using cryopreserved serum samples. No
significant difference was found between anti-VZV titers in 13 patients with VZV 
infection (localized zoster in 11 patients and disseminated zoster in 2 patients)
and in 13 subjects without VZV infection at each time point after HSCT.
Preexisting anti-VZV titers of disseminated zoster cases tended to be lower than 
those of localized zoster cases (P=0.10). Serum VZV DNA copy numbers at the onset
of disseminated zoster cases tended to be higher than those of localized zoster
cases (P=0.09). A strong inverse correlation was found between preexisting
anti-VZV titer and serum VZV DNA at onset (r=-0.90, P=0.006). In HSCT recipients,
preexisting antibody does not prevent the development of VZV reactivation but may
contribute to decreased viral load at onset, resulting in a mild clinical course.

PMID: 17035500 [PubMed - indexed for MEDLINE]

385: J Med Microbiol. 2006 Nov;55(Pt 11):1587-90.

Comment in:
    J Med Microbiol. 2007 Sep;56(Pt 9):1253; author reply 1254.

Intractable colitis associated with chronic granulomatous disease.

Arimura Y, Goto A, Yamashita K, Endo T, Ikeda H, Tanaka K, Tsutsumi H, Shinomura 
Y, Imai K.

First Department of Internal Medicine, Sapporo Medical University, S-1, W-16,
Chuo-ku, Sapporo 060-8543, Japan. arimura@sapmed.ac.jp

The case of a 20-year-old Japanese man, diagnosed as having autosomal recessive
chronic granulomatous disease (CGD), who was being treated with corticosteroids
for intractable unclassified colitis, is described. He died from multiple organ
failure following disseminated intravascular coagulation secondary to
disseminated varicella-zoster virus (VZV) infection. He was diagnosed as an index
case of CGD when 2 years old, was inoculated against VZV at the age of 5 years
and had had an unremarkable course for 19 years. He was admitted to hospital
because of a third episode of recurrent bloody diarrhoea. Clinical remission for 
each episode was achieved by intravenous corticosteroid therapy. Unclassified
colitis associated with CGD was diagnosed based on a colonic biopsy demonstrating
characteristic macrophages with lipofuscin deposits. From a treatment viewpoint, 
idiopathic inflammatory bowel disease (IBD) should be differentiated from
secondary IBD occurring in CGD, in which immunosuppressive drugs including
corticosteroids, still the mainstay of IBD treatment, should be avoided.

Publication Types: 
    Case Reports

PMID: 17030921 [PubMed - indexed for MEDLINE]

386: Rev Neurol (Paris). 2006 Sep;162(8-9):879-87.

[Neurological complications of Herpes zoster]

[Article in French]

Mathis S, Gil R, Neau JP.

Clinique Neurologique, CHU La Miletrie, Poitiers.

INTRODUCTION: Herpes zoster is a disease which occurs secondary to the
reactivation of varicella-zoster virus (VZV). Its frequency is high in the
general population. STATE OF ART: Herpes zoster leads to numerous complications, 
among which there were neurological peripheral or central lesions. Antiviral
treatment must be instituted, particularly if neurological complications develop,
as soon as possible. Corticosteroid therapy can be used, especially in
Ramsay-Hunt syndrome or central nervous system involvement. CONCLUSION:
Herpes-zoster is a frequent disease which can lead to serious neurological
complications. Early treatment is necessary in order to improve functional
outcome.

Publication Types: 
    English Abstract
    Review

PMID: 17028554 [PubMed - indexed for MEDLINE]

387: J Neuropathol Exp Neurol. 2006 Oct;65(10):1022-30.

Latency of alpha-herpes viruses is accompanied by a chronic inflammation in human
trigeminal ganglia but not in dorsal root ganglia.

Hufner K, Derfuss T, Herberger S, Sunami K, Russell S, Sinicina I, Arbusow V,
Strupp M, Brandt T, Theil D.

Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University,
Munich, Germany.

The immune response to latent herpesvirus infections was compared in human
trigeminal ganglia (TG) and dorsal root ganglia (DRG) of 15 dead individuals. On 
the basis of our previous findings, we hypothesized that T-cells would be
attracted to sensory neurons latently infected with herpes simplex virus type 1
(HSV-1), but not to those harboring latent varicella zoster virus (VZV). We
showed that the TG contain a positive hybridization signal for HSV-1
latency-associated transcript (LAT), whereas the DRG from the same individuals
lack detectable LAT. In contrast, immunohistochemistry revealed that latent VZV
protein 62 stained positive in the vast majority of all tested TG and DRG. T-cell
infiltrates prominently surrounded individual neurons in the TG but not in the
DRG. TaqMan polymerase chain reaction also showed higher expression of CD8 and
RANTES transcripts in the TG versus DRG. Only the infiltrates in the TG, but not 
in the DRG, produced RANTES at the protein level. Because it has been shown that 
RANTES protein is produced only after T-cell receptor stimulation, we assume that
T-cell infiltration is associated with antigen recognition in the TG but not in
the DRG.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17021407 [PubMed - indexed for MEDLINE]

388: Aust Fam Physician. 2006 Oct;35(10):789-90.

Localised herpes zoster infection and SIADH.

O'Rourke F, Chilov M.

Aged Care and Rehabilitation, Bankstown- Lidcombe Hospital, New South Wales,
Australia. fintan.o'rourke@swsahs.nsw.gov.au

Localised herpes zoster infection ('shingles') in older patients is a common
presentation to primary, and sometimes secondary, care physicians. However,
symptoms of hyponatraemia, caused by the rare complication of 'syndrome of
inappropriate antidiuretic hormone secretion' (SIADH), may be mistaken for
constitutional symptoms of the infection itself. Such patients may require closer
monitoring or hospitalisation.

Publication Types: 
    Case Reports

PMID: 17019453 [PubMed - indexed for MEDLINE]

389: J Dtsch Dermatol Ges. 2006 Oct;4(10):871-9; quiz 880-1.

Zoster-associated neuralgias.

[Article in English, German]

Wassilew SW.

Dermatology Clinic, Krefeld, Germany. dermatologie@klinikum-krefeld.de

Publication Types: 
    Review

PMID: 17010178 [PubMed - indexed for MEDLINE]

390: Int Wound J. 2006 Jun;3(2):145-6.

Nocturnal sedation in a child with facial ulceration.

Patel GK, Motley RJ.

Welsh Institute of Dermatology, University Hospital of Wales, Heath Park,
Cardiff, UK. patelgk@cf.ac.uk

Mostly, herpes zoster affects adults and therefore childhood presentation can
represent a diagnostic challenge. Childhood herpes zoster, when it occurs, can
also be associated with peripheral nerve complications, as illustrated by this
case. A 3-year-old child who had herpes zoster developed a nasolabial scar
resulting in a shallow non-healing ulcer from being repeatedly picked. Healing
was only achieved after nocturnal sedation, with chloral hydrate.

Publication Types: 
    Case Reports

PMID: 17007345 [PubMed - indexed for MEDLINE]

391: Pancreas. 2006 Oct;33(3):314-5.

Shingles-associated Pancreatitis.

Famularo G, Minisola G, Nicotra GC.

Publication Types: 
    Case Reports
    Letter

PMID: 17003657 [PubMed - indexed for MEDLINE]

392: Rheumatology (Oxford). 2006 Nov;45(11):1370-5. Epub 2006 Sep 26.

Rates and predictors of herpes zoster in patients with rheumatoid arthritis and
non-inflammatory musculoskeletal disorders.

Wolfe F, Michaud K, Chakravarty EF.

National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation, 
1035 N. Emporia, Suite 230 Wichita, KS 67214, USA. fwolfe@arthritis-research.org

OBJECTIVES: Herpes zoster (HZ) is a common disorder that causes substantial pain 
and morbidity. We examined its rate and predictors in rheumatoid arthritis (RA)
and non-inflammatory musculoskeletal (MSK) disorders to determine if HZ was
increased in RA and whether treatment contributed to the risk of HZ. METHODS:
After excluding patients witzh prior HZ, we assessed 10 614 RA and 1721 MSK
patients by semi-annual questionnaires during 33 825 patient-years of follow-up. 
Predictors of HZ were determined by Cox regression and expressed as hazard ratios
(HR) and 95% confidence intervals (CI). RESULTS: The annualized incidence rate
per 1000 patient-years was 13.2 (95% CI 11.9-14.5) in RA and 14.6 (95% CI
11.2-18.1) in MSK, and did not differ significantly after adjustment for age and 
sex. HZ was predicted by impaired functional status, as measured by the Health
Assessment Questionnaire (HAQ), [HR 1.3 (95% CI 1.1-1.5)] and by the use of
COX-2-specific non-steroidal anti-inflammatory drugs (NSAIDs) [HR 1.3 (95% CI
1.1-1.6)] in RA and MSK. In multivariable analyses in patients with RA,
cyclophosphamide HR 4.2 (95% CI 1.6-11.5), azathioprine HR 2.0 (1.2-3.3),
prednisone HR 1.5 (1.2-1.8), leflunomide HR 1.4 (1.1-1.8) and COX-2 NSAIDs HR 1.3
(95% CI 1.1-1.6) were significant predictors of HZ. CONCLUSION: The incidence of 
HZ is increased in RA and MSK compared with population-based rates. However, the 
rate of HZ in RA is not increased compared with MSK. After adjustment for
severity, various treatments, but not methotrexate or biologics, were risk
factors for HZ.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 17003175 [PubMed - indexed for MEDLINE]

393: Acta Dermatovenerol Alp Panonica Adriat. 2006 Jun;15(2):94-7.

Zosteriform lichen planus-like eruption.

Miljkovic J, Belic M, Godic A, Klemenc P, Marin J.

Department of Dermatology and Venereology, General Hospital Maribor, Ljubljanska 
5, 2000 Maribor, Corresponding author. miljkovic.j@sb-mb.si.

Lichen planus (LP) is a relatively common papulosquamous skin disease of unknown 
etiology, it is believed to be a T-cell mediated disorder. In addition to the
cutaneous eruptions it may also affect mucous membranes, nails or cause scarring 
alopecia. Lichen planus appears in various clinical variants which are
categorized according to the morphology and configuration of lesions. We present 
a 34-year-old man who developed a papular eruption localized unilaterally on the 
right side of the body in a linear-zosteriform pattern within the L5-S1 nerve
segments. The skin lesions clinically and histologically mimicked LP. Topical
treatment with betamethason ointment for one month led to remarkable improvement,
but a zosteriform hiperpigmentation persisted. According to the clinical findings
in our patient and a review of the literature, we believe that
lichenoidzosteriform eruption is a variant of lichen planus or a herpes zoster
infection.

PMID: 16998610 [PubMed - in process]

394: Ophthalmology. 2006 Dec;113(12):2259-61. Epub 2006 Sep 25.

Primary treatment of acute retinal necrosis with oral antiviral therapy.

Emerson GG, Smith JR, Wilson DJ, Rosenbaum JT, Flaxel CJ.

Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.

PURPOSE: To explore the possibility of oral antiviral therapy in lieu of
intravenous acyclovir for treating acute retinal necrosis (ARN), a necrotizing
retinopathy caused by herpes simplex virus type 1 or 2 or by varicella zoster
virus. DESIGN: Retrospective, interventional, small case series. PARTICIPANTS:
Four patients (6 eyes). METHODS: Patients were treated with oral antiviral
therapy. Medications included valacyclovir (1 g 3 times daily), oral famciclovir 
(500 mg 3 times daily), and topical and oral corticosteroids. MAIN OUTCOME
MEASURES: Improvement of symptoms, including photophobia, blurred vision, ocular 
discomfort, and floaters; increase in visual acuity; and resolution of vitreitis,
retinitis, and retinal vasculitis, where present. RESULTS: Symptoms and visual
acuity improved within 2 weeks to 1 month in 3 of 4 patients (75%) treated with
oral antiviral medication. One patient required surgical treatment for
asymptomatic retinal detachment after 3 weeks of treatment; retinal detachment in
the fellow eye was repaired 2 months later. Duration of antiviral therapy ranged 
from 5 weeks to 3 months. CONCLUSIONS: For 4 patients with relatively indolent
cases of ARN, oral antiviral therapy alone was effective in eliminating signs and
symptoms of the disease. In particular, oral valacyclovir and famciclovir
appeared to be effective, although further study is necessary to determine
whether these drugs are as effective as intravenous acyclovir for initial
treatment of ARN.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16996614 [PubMed - indexed for MEDLINE]

395: Expert Rev Vaccines. 2006 Aug;5(4):431-43.

Prevention of shingles by varicella zoster virus vaccination.

Holodniy M.

VA Palo Alto Health Care System, 3801 Miranda Ave. (132), Palo Alto, CA 94306,
USA. mark.holodniy@va.gov

Herpes zoster is caused by reactivation from previous varicella zoster virus
(VZV) infection, and affects millions of people worldwide. It primarily affects
older adults and those with immune system dysfunction, most likely as a result of
reduced or lost VZV-specific cell-mediated immunity. Complications include
post-herpetic neuralgia, a potentially debilitating and chronic pain syndrome.
Current treatment of herpes zoster and post-herpetic neuralgia involves antiviral
agents and analgesics, and is associated with significant economic cost. Results 
from several clinical trials have determined that a live, attenuated VZV vaccine 
using the Oka/Merck strain (Zostavax) is safe, elevates VZV-specific
cell-mediated immunity, and significantly reduces the incidence of herpes zoster 
and post-herpetic neuralgia in people over 60 years of age. Regulatory approval
has recently been obtained and once launched, it is expected that this vaccine
will significantly reduce the morbidity and financial costs associated with
herpes zoster. Durability of vaccine response and possible booster vaccination
will still need to be determined.

Publication Types: 
    Review

PMID: 16989624 [PubMed - indexed for MEDLINE]

396: Consum Rep. 2006 Oct;71(10):62.

Vaccines: more reasons to immunize.

[No authors listed]

PMID: 16981311 [PubMed - indexed for MEDLINE]

397: Toxicon. 2006 Dec 1;48(7):810-29. Epub 2006 Jul 15.

Therapeutic applications of conotoxins that target the neuronal nicotinic
acetylcholine receptor.

Livett BG, Sandall DW, Keays D, Down J, Gayler KR, Satkunanathan N, Khalil Z.

Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and
Biotechnology Institute, University of Melbourne, Victoria 3010, Australia.
b.livett@unimelb.edu.au

Pain therapeutics discovered by molecular mining of the expressed genome of
Australian predatory cone snails are providing lead compounds for the treatment
of neurological diseases such as multiple sclerosis, shingles, diabetic
neuropathy and other painful neurological conditions. The high specificity
exhibited by these novel compounds for neuronal receptors and ion channels in the
brain and nervous system indicates the high degree of selectivity that this class
of neuropeptides can be expected to show when used therapeutically in humans. A
lead compound, ACV1 (conotoxin Vc1.1 from Conus victoriae), has entered Phase II 
clinical trials and is being developed for the treatment for neuropathic pain.
ACV1 will be targeted initially for the treatment of sciatica, shingles and
diabetic neuropathy. The compound is a 16 amino acid peptide [Sandall et al.,
2003. A novel alpha-conotoxin identified by gene sequencing is active in
suppressing the vascular response to selective stimulation of sensory nerves in
vivo. Biochemistry 42, 6904-6911], an antagonist of neuronal nicotinic
acetylcholine receptors. It has potent analgesic activity following subcutaneous 
or intramuscular administration in several preclinical animal models of human
neuropathic pain [Satkunanathan et al., 2005. Alpha conotoxin Vc1.1 alleviates
neuropathic pain and accelerates functional recovery of injured neurons. Brain.
Res. 1059, 149-158]. ACV1 may act as an analgesic by decreasing ectopic
excitation in sensory nerves. In addition ACV1 appears to accelerate the recovery
of injured nerves and tissues.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16979678 [PubMed - indexed for MEDLINE]

398: Med Lett Drugs Ther. 2006 Sep 11;48(1243):73-4.

Herpes zoster vaccine (Zostavax).

[No authors listed]

A live attenuated varicella-zoster vaccine (Zostavax--Merck) has been approved by
the FDA for prevention of herpes zoster (HZ; zoster; shingles) in persons > or = 
60 years old. Each dose of Zostavax contains about 14 times as much
varicella-zoster virus (VZV) as Varivax, which has been used in the US since 1995
to vaccinate against varicella (chicken pox).

PMID: 16977285 [PubMed - indexed for MEDLINE]

399: J Virol. 2006 Dec;80(23):11806-16. Epub 2006 Sep 13.

ORF66 protein kinase function is required for T-cell tropism of varicella-zoster 
virus in vivo.

Schaap-Nutt A, Sommer M, Che X, Zerboni L, Arvin AM.

Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur
Drive, Stanford, CA 94305-5208, USA. anne.s.nutt@gmail.com

Several functions have been attributed to the serine/threonine protein kinase
encoded by open reading frame 66 (ORF66) of varicella-zoster virus (VZV),
including modulation of the apoptosis and interferon pathways, down-regulation of
major histocompatibility complex class I cell surface expression, and regulation 
of IE62 localization. The amino acid sequence of the ORF66 protein contains a
recognizable conserved kinase domain. Point mutations were introduced into
conserved protein kinase motifs to evaluate their importance to ORF66 protein
functions. Two substitution mutants were generated, including a G102A
substitution, which blocked autophosphorylation and altered IE62 localization,
and an S250P substitution, which had no effect on either autophosphorylation or
IE62 localization. Both kinase domain mutants grew to titers equivalent to
recombinant parent Oka (pOka) in vitro. pOka66G102A had slightly reduced growth
in skin, which was comparable to the reduction observed when ORF66 translation
was prevented by stop codon insertions in pOka66S. In contrast, infection of
T-cell xenografts with pOka66G102A was associated with a significant decrease in 
infectious virus production equivalent to the impaired T-cell tropism found with 
pOka66S infection of T-cell xenografts in vivo. Disrupting kinase activity with
the G102A mutation did not alter IE62 cytoplasmic localization in VZV-infected T 
cells, suggesting that decreased T-cell tropism is due to other ORF66 protein
functions. The G102A mutation reduced the antiapoptotic effects of VZV infection 
of T cells. These experiments indicate that the T-cell tropism of VZV depends
upon intact ORF66 protein kinase function.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16971426 [PubMed - indexed for MEDLINE]

400: Arch Neurol. 2006 Sep;63(9):1327.

Abdominal pseudohernia caused by herpes zoster truncal D12 radiculoneuropathy.

Mancuso M, Virgili MP, Pizzanelli C, Chiari A, Geri G, Michelassi MC, Galli R.

Unit of Neurophysiopathology, Hospital Lotti, 56126 Pontedera, Italy.
mmancuso@inwind.it

Publication Types: 
    Case Reports

PMID: 16966515 [PubMed - indexed for MEDLINE]

401: J Pediatr Health Care. 2006 Sep-Oct;20(5):300-3.

Herpes zoster in childhood.

Leung AK, Robson WL, Leong AG.

Department of Pediatrics, University of Calgary, Alberta, Canada.

Herpes zoster is caused by reactivation of latent varicella-zoster virus that
resides in a dorsal root ganglion. Herpes zoster can develop any time after a
primary infection. Because varicella vaccine is a live attenuated virus, herpes
zoster can develop in a vaccine recipient. The incidence of herpes zoster among
vaccine recipients is about 14 cases per 100,000 person-years. In young children,
herpes zoster has a predilection for areas supplied by the cervical and sacral
dermatomes. The most common complications are secondary bacterial infection,
depigmentation, and scarring. Although the diagnosis of herpes zoster is based on
a distinct clinical appearance, viral DNA analysis of the lesion by polymerase
chain reaction or restriction fragment length polymorphism is necessary to
differentiate wild from vaccine-type viruses. Acyclovir is the treatment of
choice for herpes zoster.

Publication Types: 
    Review

PMID: 16962434 [PubMed - indexed for MEDLINE]

402: Dermatol Online J. 2006 Sep 8;12(5):3.

Zosteriform lichen planus.

Perry D, Fazel N.

University of California Davis, Department of Dermatology, USA.

A 95-year-old woman presented with a 4-month history of a pruritic eruption
involving her trunk, medial thighs, and lesions limited to the C5 dermatome of
the left upper extremity. Punch biopsy supported a clinical diagnosis of
zosteriform lichen planus. Linear lichen planus refers to lichen planus with a
unilateral linear distribution. This variant may present as an example of the
Wolf isotopic response, or more rarely, a de novo eruption on previously-normal
skin. In very rare instances linear lichen planus presents in a segmental fashion
corresponding to a dermatome and is termed zosteriform lichen planus.

Publication Types: 
    Case Reports

PMID: 16962018 [PubMed - indexed for MEDLINE]

403: Ann Intern Med. 2006 Sep 5;145(5):386-7.

Comment on:
    Ann Intern Med. 2006 Sep 5;145(5):317-25.

Shingles vaccine: effective and costly or cost-effective?

Koplan JP, Harpaz R.

Publication Types: 
    Comment
    Editorial

PMID: 16954362 [PubMed - indexed for MEDLINE]

404: Ann Intern Med. 2006 Sep 5;145(5):317-25.

Comment in:
    Ann Intern Med. 2006 Sep 5;145(5):386-7.

Summary for patients in:
    Ann Intern Med. 2006 Sep 5;145(5):I14.

Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic
neuralgia in older adults.

Hornberger J, Robertus K.

SPHERE Institute and Acumen LLC, Burlingame, California 94010, USA.
jhornberger@acumen-llc.com

BACKGROUND: The Shingles Prevention Study showed that a varicella-zoster virus
(VZV) vaccine administered to adults 60 years of age or older reduced the
incidence of herpes zoster from 11.12 to 5.42 cases per 1000 person-years. Median
follow-up was 3.1 years, and relative risk reduction was 51.3% (95% CI, 44.2% to 
57.6%). OBJECTIVE: To assess the extent to which clinical and cost variables
influence the cost-effectiveness of VZV vaccination for preventing herpes zoster 
in immunocompetent older adults. DESIGN: Decision theoretical model. DATA
SOURCES: English-language data published to March 2006 identified from MEDLINE on
herpes zoster rates, vaccine effectiveness, quality of life, medical resource
use, and unit costs. Target Population: Immunocompetent adults 60 years of age or
older with a history of VZV infection. Time Horizon: Lifetime. Perspective: U.S. 
societal. Interventions: Varicella-zoster virus vaccination versus no
vaccination. Outcome Measures: Incremental quality-adjusted survival and cost per
quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis: By
reducing incidence and severity of herpes zoster, vaccination can increase
quality-adjusted survival by 0.6 day compared with no vaccination. One scenario
in which vaccination costs less than 100,000 dollars per QALY gained is when 1)
the unit cost of vaccination is less than 200 dollars, 2) the age at vaccination 
is less than 70 years, and 3) the duration of vaccine efficacy is more than 30
years. Results of Sensitivity Analysis: Vaccination would be more cost-effective 
in "younger" older adults (age 60 to 64 years) than in "older" older adults (age 
> or =80 years). Longer life expectancy and a higher level of vaccine efficacy
offset a lower risk for herpes zoster in the younger group. Other factors
influencing cost-effectiveness include quality-of-life adjustments for acute
zoster, unit cost of the vaccine, risk for herpes zoster, and duration of vaccine
efficacy. LIMITATIONS: The effectiveness of VZV vaccination remains uncertain
beyond the median 3.1-year duration of follow-up in the Shingles Prevention
Study. CONCLUSIONS: Varicella-zoster virus vaccination to prevent herpes zoster
in older adults would increase QALYs compared with no vaccination. Resolution of 
uncertainties about the average quality-of-life effects of acute zoster and the
duration of vaccine efficacy is needed to better determine the cost-effectiveness
of zoster vaccination in older adults.

PMID: 16954357 [PubMed - indexed for MEDLINE]

405: Ann Intern Med. 2006 Sep 5;145(5):I14.

Original report in:
    Ann Intern Med. 2006 Sep 5;145(5):317-25.

Summaries for patients. Cost-effectiveness of a vaccine to prevent herpes zoster 
(shingles) in older adults.

[No authors listed]

Publication Types: 
    Patient Education Handout

PMID: 16954354 [PubMed - indexed for MEDLINE]

406: J Clin Microbiol. 2006 Sep;44(9):3094-7.

Serological detection of varicella-zoster virus-specific immunoglobulin G by an
enzyme-linked immunosorbent assay using glycoprotein antigen.

Sauerbrei A, Wutzler P.

Institute of Virology and Antiviral Therapy, University Clinic of Jena, Postfach,
Hans-Knoell-Strasse 2, D-07745 Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de

Since the introduction of varicella vaccination in several countries, there has
been an urgent need for commercially available test procedures that allow highly 
sensitive and specific quantitative determination of the varicella-zoster virus
(VZV)-specific immune status, including immunity postimmunization. This study
compared the performance of two enzyme-linked immunosorbent assays (ELISAs) for
the sensitive and specific determination of VZV-specific immunoglobulin G (IgG)
in seronegative and latently infected persons, as well as in vaccinees. One ELISA
is based on the detection of antibody to VZV-specific envelope glycoproteins
(gp), and the other comprises the whole antigen extract prepared from
VZV-infected cells. A modified standard fluorescent-antibody-to-membrane-antigen 
(FAMA) assay was used as a reference. An excellent sensitivity (100%) in relation
to FAMA was demonstrated for the gpELISA (Virion\Serion), while the non-gpELISA
(Dade Behring) had a lower sensitivity (83%) when sera from latently infected
persons were tested. After postvaccinal immunity was measured, a sensitivity of
87% was achieved with gpELISA, whereas the ELISA incorporating antigen extract of
VZV-infected cells had a sensitivity of 78%. Excellent specificity (100%) was
calculated for both the gpELISA and the non-gpELISA. In conclusion, SERION ELISA 
classic VZV IgG is useful for the sensitive and specific quantitative
determination of VZV immune status after natural infection. The test can also be 
recommended for measuring antibody response after varicella vaccination,
particularly after the cutoff value was optimized.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 16954232 [PubMed - indexed for MEDLINE]

407: Nursing. 2006 Sep;36(9):25-6.

Heading off the pain of postherpetic neuralgia.

D'Arcy Y.

Pain Management and Palliative Care, Suburban Hospital, Bethesda, MD, USA.

PMID: 16951600 [PubMed - indexed for MEDLINE]

408: Photodermatol Photoimmunol Photomed. 2006 Oct;22(5):232-7.

Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence
and severity of postherpetic neuralgia.

Jalali MH, Ansarin H, Soltani-Arabshahi R.

Department of Dermatology, Hazrat-e Rasool University Hospital, Iran University
of Medical Sciences, Tehran, Iran.

BACKGROUND: Postherpetic neuralgia (PHN) is one of the common complications of
herpes zoster infection, particularly in the elderly. Current therapeutic
measures are only partially effective in the affected patients. As inflammatory
mediators released by different cells play an important role in the pathogenesis 
of this neuropathic pain and with regard to the immunomodulatory effects of
ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be
effective in the prevention of PHN. METHOD: This study was performed in two
phases. Phase I was a prospective open controlled trial. Twenty-five patients
with severe pain in the first 7 days of zoster rash were divided into two groups:
the prevention group (n=12) received oral acyclovir (800 mg five times a day for 
10 days) plus broad-band UVB to the affected dermatomes, starting with 20
mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a
maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week
until pain relief or to a maximum of 15 sessions. The control group (n=13), who
had disease characteristics similar to the prevention group, received only oral
acyclovir with the same dose. All patients reported their severity of pain on a
verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months'
follow-up. In phase II of the study, five patients with established PHN (more
than 3 months after rash onset) received UVB with the above-mentioned protocol.
RESULTS: A total of 17 patients older than 40 (10 females, seven males; mean age,
65.5 years; range: 47-82 years) who had intractable pain due to zoster infection 
received UVB in two phases of the study. In patients who received phototherapy in
the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and
3-month follow-up, respectively. The corresponding figure in the control group
was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity 
of pain was also lower in the phototherapy group than the control group (mean VRS
2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3
months after rash onset (established PHN) experienced significant (more than 50%)
pain relief. CONCLUSION: UVB phototherapy in the acute stage of zoster rash might
reduce the incidence and severity of PHN. Treatment after 3 months does not seem 
to have a significant beneficial effect.

Publication Types: 
    Controlled Clinical Trial

PMID: 16948824 [PubMed - indexed for MEDLINE]

409: S D Med. 2006 Aug;59(8):349-50.

Shingles vaccine: who should get it?

Johnson AM.

South Dakota State University, VA Medical Center, Sioux Falls, USA.

PMID: 16941852 [PubMed - indexed for MEDLINE]

410: Int J Toxicol. 2006 Sep-Oct;25(5):313-7.

The case against universal varicella vaccination.

Goldman GS.

Medical Veritas International Inc., Pearblossom, California 93553, USA.
pearblossominc@aol.com

In 1995, the United States became the first country to implement a Universal
Varicella Vaccination Program. Several questions remain: Is the varicella
(chickenpox) vaccine needed? Is it cost effective as a routine immunization for
all susceptible children? Or is it more beneficial for the disease to remain
endemic so that adults may receive periodic exogenous exposures (boosts) that
help suppress the reactivation of herpes zoster (shingles). In addition, as
vaccination coverage becomes widespread, does loss of immunologic boosting cause 
a decline in vaccine efficacy and result in a reduced period of immunity?
Scientific literature regarding safety of the varicella vaccine and its
associated cost-benefit analysis have often reported optimistic evaluations based
on ideal assumptions. Deleterious outcomes and their associated costs must be
included when making a circumspect assessment of the Universal Varicella
Vaccination Program.

PMID: 16940003 [PubMed - indexed for MEDLINE]

411: J Laryngol Otol. 2006 Sep;120(9):745-8.

Delayed facial nerve palsy following tympano-mastoid surgery: incidence,
aetiology and prognosis.

Safdar A, Gendy S, Hilal A, Walshe P, Burns H.

Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin,
Republic of Ireland. adnan_safdar@hotmail.com

OBJECTIVE: To establish the frequency of occurrence of delayed facial nerve
paralysis following tympano-mastoid surgery in our department and to determine
the aetiological factors and long term prognosis. SETTING: Tertiary care academic
centre. MATERIALS AND METHODS: A retrospective review of all patients who had
undergone tympano-mastoid surgery in our department over the previous five years 
was carried out. A total of 219 patients were included in the study. Only two
patients were identified as having delayed onset facial nerve palsy over this
period of time. The patients' medical records were reviewed and the patients
clinically assessed. RESULTS: The frequency of delayed onset facial nerve palsy
following tympano-mastoid surgery in our series was 0.91 per cent. Facial
weakness set in on day eight and day 14 in the two patients. Serological
investigations in both patients revealed raised titres of immunoglobulin (Ig) M
and IgG to varicella-zoster virus, confirming the presence of varicella-zoster
infection. In our experience, the combined use of prednisone and acyclovir was an
effective form of treatment for both patients, whose facial nerve function fully 
recovered within six months of onset. CONCLUSION: The incidence of delayed facial
nerve palsy following tympano-mastoid surgery is low. It can occur up to two
weeks after the surgery. Our two cases confirm viral reactivation to be an
important aetiological factor in the development of delayed onset facial nerve
palsy. The overall prognosis for delayed facial nerve palsy following
tympano-mastoid surgery appears to be good.

PMID: 16939665 [PubMed - indexed for MEDLINE]

412: Br J Nurs. 2006 Aug 10-Sep 13;15(15):814-8.

Managing pain after shingles: a nursing perspective.

Hawksley H.

Chronic Pain Management Services, Chronic Pain Management Department, Ashford and
St Peter's Hospitals NHS Trust, Chertsey, Surrey.

Post-herpetic neuralgia (PHN) is the neuropathic pain syndrome that may develop
following an attack of shingles. While for many the symptoms subside, there can
be long-term pain problems for up to 40% of those affected with PHN, and for 3%
of these, symptoms can be severe (Dworkin and Portenoy, 1996). Knowledge and
understanding of the symptoms and various treatments and approaches available is 
important to enable nurses and patients to work together in partnership to
achieve the best outcomes. Realizing that more than one approach may be needed
can allow for treatments which are complementary and for optimization of both
biomedical and self-care approaches.

Publication Types: 
    Review

PMID: 16936604 [PubMed - indexed for MEDLINE]

413: Ann Rheum Dis. 2007 Feb;66(2):228-34. Epub 2006 Aug 25.

Selective costimulation modulation using abatacept in patients with active
rheumatoid arthritis while receiving etanercept: a randomised clinical trial.

Weinblatt M, Schiff M, Goldman A, Kremer J, Luggen M, Li T, Chen D, Becker JC.

Rheumatology and Immunology, Brigham and Women's Hospital, 75 Francis Street,
Boston, MA 02115, USA. mweinblatt@partners.org

OBJECTIVE: To investigate the efficacy and safety of abatacept in combination
with etanercept in patients with active rheumatoid arthritis during a 1-year,
randomised, placebo-controlled, double-blind phase, followed by an open-label,
long-term extension (LTE). METHODS: Patients continued etanercept (25 mg twice
weekly) and were randomised to receive abatacept 2 mg/kg (n = 85) or placebo (n =
36). As the effective dose of abatacept was established as 10 mg/kg in a separate
trial, all patients received abatacept 10 mg/kg and etanercept during the LTE.
RESULTS: A total of 121 patients were randomised; 80 completed double-blind
treatment and entered the LTE. During double-blind treatment, the difference in
the percentage of patients achieving the primary end point (modified American
College of Rheumatology (ACR) 20 response at 6 months) was not significant
between groups (48.2% v 30.6%; p = 0.072). At 1 year, no notable changes in
modified ACR responses were observed. Subsequent to the dosing change, similar
modified ACR responses were seen during the LTE. Significant improvements in
quality of life were observed with abatacept and etanercept versus placebo and
etanercept in five of the eight short-form 36 subscales at 1 year. More abatacept
and etanercept-treated patients experienced serious adverse events (SAEs) at 1
year than patients receiving placebo and etanercept (16.5% v 2.8%), with 3.5% v
0% experiencing serious infections. CONCLUSION: The combination of abatacept (at 
a dose of 2 mg/kg during the double-blind phase and 10 mg/kg during the LTE) and 
etanercept was associated with an increase in SAEs, including serious infections,
with limited clinical effect. On the basis of the limited efficacy findings and
safety concerns, abatacept in combination with etanercept should not be used for 
rheumatoid arthritis treatment.

Publication Types: 
    Clinical Trial, Phase II
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16935912 [PubMed - indexed for MEDLINE]

414: Am J Ophthalmol. 2006 Sep;142(3):393-9.

Herpes zoster ophthalmicus in otherwise healthy children.

De Freitas D, Martins EN, Adan C, Alvarenga LS, Pavan-Langston D.

Department of Ophthalmology, Federal University of Sao Paulo, SP, Rua Botucatu,
Sao Paulo, Brazil.

PURPOSE: To evaluate the complications of herpes zoster ophthalmicus (HZO) in
children. DESIGN: Prospective-observational case series. METHODS: Ten healthy
patients (five boys, five girls) with HZO were prospectively followed. Data
regarding best-corrected visual acuity, biomicroscopy, intraocular pressure,
corneal sensitivity, and funduscopy were collected. The median duration of
follow-up was 19 months (range eight to 78 months). RESULTS: The mean age at
presentation was 8.7 years (range two to 14 years +/-3.95). At last visit, two
patients (20%) had decreased visual acuity and nine (90%) had some degree of
abnormal corneal sensitivity and corneal opacity despite good final visual
acuity. CONCLUSION: In general, HZO seems to have a good prognosis in healthy
children; nonetheless, some cases can present severe eye complications causing
visual loss.

PMID: 16935582 [PubMed - indexed for MEDLINE]

415: Nat Clin Pract Neurol. 2006 Jun;2(6):298-9.

Does acute pain associated with herpes zoster respond to treatment with
gabapentin?

Moulin D.

Department of Clinical Neurological Sciences, University of Western Ontario,
London, ON, Canada. dwight.moulin@lhsc.on.ca

PMID: 16932569 [PubMed - indexed for MEDLINE]

416: Nat Clin Pract Neurol. 2005 Nov;1(1):18-9.

Comment on:
    N Engl J Med. 2005 Jun 2;352(22):2271-84.

Can vaccinating older adults against varicella zoster virus prevent herpes zoster
and postherpetic neuralgia?

Steiner I.

Department of Neurology, Hadassah University Hospital, Jerusalem, Israel.
isteiner@md2.huji.ac.il

Publication Types: 
    Comment

PMID: 16932487 [PubMed]

417: Clin J Oncol Nurs. 2006 Aug;10(4):463-4.

Rash: is it shingles?

Marrs JA.

Hematology and Oncology Associates, Dayton, Ohio, USA. joycemrn@sbcglobal.net

CASE PRESENTATION: Mrs. Smith, a 56-year-old Caucasian woman, was seen in the
office for complaints of a rash at her waist. She completed three cycles of
dose-dense cyclophosphamide and doxorubicin chemotherapy for stage III breast
cancer. The third cycle was 10 days prior. Grade III neutropenia was the only
complete blood count abnormality.

Publication Types: 
    Case Reports

PMID: 16927898 [PubMed - indexed for MEDLINE]

418: Dent Update. 2006 Jul-Aug;33(6):378.

Comment on:
    Dent Update. 2006 May;33(4):252.

Physical signs for the general dental practitioner: case 34, Herpes zoster (Dent 
Update 2006; 33: 252).

Hodges S.

Publication Types: 
    Comment
    Letter

PMID: 16924733 [PubMed - indexed for MEDLINE]

419: Arch Dermatol. 2006 Aug;142(8):1069.

Comment on:
    Arch Dermatol. 2006 Feb;142(2):264.

A unique pattern of hyperhidrosis and herpes zoster.

Wu JJ, Murase JE, Huang DB, Tyring SK.

Publication Types: 
    Comment
    Letter

PMID: 16924065 [PubMed - indexed for MEDLINE]

420: Health News. 2006 Aug;12(8):2.

Shingles vaccine gets the FDA nod.

[No authors listed]

Publication Types: 
    News

PMID: 16917965 [PubMed - indexed for MEDLINE]

421: An Med Interna. 2006 May;23(5):249-50.

[Acute cerebellar ataxia in an adult]

[Article in Spanish]

Campos Franco J, Rodriguez Framil M, Martinez Rey C, Pose Reino A.

Publication Types: 
    Case Reports
    Letter

PMID: 16913074 [PubMed - indexed for MEDLINE]

422: Oral Dis. 2006 Sep;12(5):500-5.

Herpes zoster in HIV infection with osteonecrosis of the jaw and tooth
exfoliation.

Siwamogstham P, Kuansuwan C, Reichart PA.

Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.

BACKGROUND: Herpes zoster (HZ) infection of the trigeminal nerve is associated
with complications such as postherpetic neuralgia, facial scarring, loss of
hearing ability and conjunctivitis. Until 2005, postherpetic alveolar necrosis
and spontaneous tooth exfoliation have been described in 20 cases unrelated to
HIV infection. OBJECTIVE: The aim of this study was to describe HIV infection in 
patients (two women, two men, average age 30 years) who suffered from HZ attacks 
to their trigeminal nerves. MAIN OUTCOME MEASURES: None of the patients had
received antiherpetic medications or antiretroviral therapy. HIV infection was
only diagnosed after the development of HZ. Facial scarring with depigmentation
and hyperesthesia (postherpetic neuralgia) was diagnosed in all four patients.
Oral findings consisted of spontaneous loss of both maxillary or mandibular
teeth. Osteonecrosis of varying extent was also found. Treatment consisted of
extractions of teeth and administration of antibiotics and analgesics. Healing of
alveolar wounds was unremarkable. CONCLUSION: Complications affecting the
alveolar bone and teeth seem to be rare in HIV-infected patients.

Publication Types: 
    Case Reports

PMID: 16910922 [PubMed - indexed for MEDLINE]

423: Clin Exp Dermatol. 2006 Sep;31(5):714-5.

Tufted angioma in site of healed herpes zoster: isotopic response.

Kim CY, Nam YH, Kim GD, Oh CW.

Publication Types: 
    Case Reports
    Letter

PMID: 16901320 [PubMed - indexed for MEDLINE]

424: Lakartidningen. 2006 Jul 12-25;103(28-29):2164.

[An unusual case]

[Article in Swedish]

Blixt L.

Publication Types: 
    Letter

PMID: 16897847 [PubMed - indexed for MEDLINE]

425: Herpes. 2006 Aug;13(2):32-6.

Varicella zoster virus: out of Africa and into the research laboratory.

Grose C.

Department of Pediatrics, Children's Hospital of Iowa, University of Iowa, Iowa
City, IA 52242, USA.

This review updates on numerous topics relating to the evolutionary origins of
varicella zoster virus (VZV), the replication cycle, virion assembly and the
recent genomic analyses. VZV is one of eight human herpesviruses that have
existed for at least 400 million years. It has co-evolved with humankind and is
present in all nationalities globally. The pathogenesis of varicella (chickenpox)
is dependent on viral replication and dispersion through the body in
T-lymphocytes. VZV replication is similar to that of herpes simplex virus. A
complete analysis of VZV transcripts has identified their relative abundance,
with transcripts for the regulatory proteins (open reading frame) ORF62 and ORF63
among the greatest. Studies of virion assembly have shown that endocytosis
pathways are involved in the envelopment process by the viral glycoproteins. The 
complete sequencing of five VZV strains has identified numerous single nucleotide
polymorphisms, and in turn, VZV strains have been segregated into European/North 
American and Asian clades. Furthermore, a small number of mutant VZV strains have
been identified. These results suggest more diversity between VZV strains than
previously recognized.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 16895651 [PubMed - indexed for MEDLINE]

426: Med Hypotheses. 2006;67(6):1411-3. Epub 2006 Aug 4.

Role of bacterial superinfections in the pathogenesis of postzosteric neuralgia.

Bassukas ID, Kiorpelidou D.

Department of Skin and Venereal Diseases, University Hospital of Ioannina,
University of Ioannina, Medical School, S. Niarhos Avenue, 45500 Ioannina,
Greece. ibassuka@cc.uoi.gr

Varicella-zoster virus (VZV) is an alpha-herpes virus that causes varicella
(chickenpox), establishes latency in dorsal root ganglia and may reactivate to
cause herpes zoster (shingles). Postherpetic neuralgia is the most common
debilitating complication of herpes zoster. It is currently supposed that
scarring of the dorsal root ganglia and atrophy of the dorsal horn as a result of
intense inflammation may play a central role in the pathogenesis of this
condition. The exact pathogenesis of the inflammatory reaction leading to
persistent ganglion damage is still poorly understood. However, immune
suppression is a recognized risk factor for the development of postzosteric
neuralgia in zoster patients (increased risk, e.g., in aged patients over 80
years or diabetes mellitus patients). There is some evidence that remote
streptococcal and staphylococcal infections may induce immunologic disease
mechanisms consequently affecting the central nervous system. Since streptococcal
and/or staphylococcal superinfection of skin lesions is common in herpes zoster, 
we present a hypothesis of immunopathogenesis of postzosteric neuralgia, i.e., as
the result of augmentation of local ganglion inflammation due to bacteria-driven 
clonal expansion of VZV-specific T-cell subsets in the affected skin. Based on
the aforementioned hypothesis it is interesting: (1) to study the impact of
concomitant systemic antibiotic treatment to the standard antiviral regimen on
the rate and severity of both bacterial superinfection of zoster skin lesions and
postzosteric neuralgia and (2) to quantify the VZV-specific T-cell response as a 
function of the degree of bacterial superinfection of zoster skin lesions.
Challenging of the present hypothesis should provide an effective means of
preventing postherpetic neuralgia by preventing and consequently treating the
bacterial superinfection of zoster skin lesions.

PMID: 16890379 [PubMed - indexed for MEDLINE]

427: J Travel Med. 2006 Jul-Aug;13(4):244-7.

Extensive cutaneous larva migrans with folliculitis mimicking multimetameric
herpes zoster presentation in an adult traveler returning from Thailand.

Malvy D, Ezzedine K, Pistone T, Receveur MC, Longy-Boursier M.

Travel Clinics and Tropical Disease Unit, Department of Internal Medicine,
Infectious Diseases and Tropical Medicine, University Hospital Center, Bordeaux, 
France.

Hookworm-related cutaneous larva migrans (CLM) is a frequent cutaneous disease
among travelers returning from the tropics. It can be misdiagnosed or treated
incorrectly. We present a 42-year-old French patient who contracted the disease
during a holiday in Thailand and who experienced an extensive CLM syndrome with a
less frequent abdominal localization and a pseudo-multimetameric homolateral
topography. The condition was late diagnosed and secondarily efficiently cured by
a unique administration of ivermectin. Simple anamnestic information--often
revealing beach activities--and clinical aspect of the creeping eruption allow to
prevent diagnosis delay and to avoid aggressive or inadequate intervention.

Publication Types: 
    Case Reports

PMID: 16884408 [PubMed - indexed for MEDLINE]

428: An Otorrinolaringol Ibero Am. 2006;33(3):225-9.

[Bogorad syndrome or crocodile tears after Ramsay-Hunt]

[Article in Spanish]

Pino Rivero V, Gonzalez Palomino A, Trinidad Ramos G, Pantoja Hernandez CG,
Marcos Garcia M, Keituqwa Yanez T, Blasco Huelva A.

Complejo Hospitalario Infanta Cristina, Badajoz. vicentepinorivero@terra.com

Crocodile tears or Bogorad Syndrome describes a complication or sequel after
facial palsy with incomplete recovery characterized by an excessive
hyperlacrimation during the food ingestion. We report the case of a 50 years old 
female with that pathology associated to facial syncinesias secondary to suffer a
right Ramsay-Hunt syndrome. Its pathogenesis and different treatment modalities
are analysed.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16881549 [PubMed - indexed for MEDLINE]

429: Indian J Dermatol Venereol Leprol. 2006 Jul-Aug;72(4):270-5.

Refining criteria for diagnosis of cutaneous infections caused by herpes viruses 
through correlation of morphology with molecular pathology.

Boer A, Herder N, Blodorn-Schlicht N, Steinkraus V, Falk TM.

Division of Dermatopathology, Dermatologikum, Hamburg, Germany.
boer@dermatologikum.de

BACKGROUND: Infections of the skin by herpes viruses do not always present
themselves in typical fashion. Early diagnosis, however, is crucial for
appropriate treatment. Polymerase chain reaction (PCR) allows diagnosis and
differential diagnosis of herpes virus infections, but the method is not yet
available in large parts of the world, where diagnosis is made based on
morphology alone. AIM: To refine criteria for the diagnosis of herpes virus
infections of the skin by way of correlation of clinical and histopathologic
findings with results of PCR studies. METHODS: We studied 75 clinically diagnosed
patients of "zoster," "varicella," and "herpes simplex", to correlate clinical
and histopathological findings with results of PCR studies on paraffin embedded
biopsy specimens. RESULTS: Clinical suspicion of infection by herpes viruses was 
confirmed by histopathology in 37% of the cases and by PCR studies in 65% of the 
cases. Zoster was frequently misdiagnosed as infection with herpes simplex
viruses (30%). When diagnostic signs of herpes virus infection were encountered
histopathologically, PCR confirmed the diagnosis in 94%. By way of correlation
with results of PCR studies, initial lesions of herpes virus infections could be 
identified to have a distinctive histopathological pattern. Herpetic folliculitis
appeared to be a rather common finding in zoster, it occurring in 28% of the
cases. CONCLUSION: We conclude that correlation of clinical and histopathological
features with results of PCR studies on one and the same paraffin embedded
specimen permits identification of characteristic morphologic patterns and helps 
to refine criteria for diagnosis both clinically and histopathologically.

Publication Types: 
    Comparative Study

PMID: 16880572 [PubMed - indexed for MEDLINE]

430: Pediatr Infect Dis J. 2006 Aug;25(8):728-32.

Herpes zoster in juvenile-onset systemic lupus erythematosus: incidence, clinical
characteristics and risk factors.

Lee PP, Lee TL, Ho MH, Wong WH, Lau YL.

Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Queen
Mary Hospital, Pokfulam, Hong Kong, China.

BACKGROUND: Herpes zoster (HZ) is common in systemic lupus erythematosus (SLE)
patients, but its clinical features and risk factors in juvenile-onset SLE have
not been well described before. METHODS: A retrospective review of the clinical
course and infections in pediatric SLE patients managed in our institution from
1988-2004 was performed. Clinical characteristics and potential risk factors for 
HZ were analyzed. RESULTS: Forty-nine children with SLE were identified. Nineteen
episodes of HZ were recorded in 15 patients, and 2 of them had recurrent HZ. The 
incidence rate was 58.7 episodes/1000 patient-years. No patient had disseminated 
HZ, postherpetic neuralgia, or cutaneous scarring, and no death was attributed to
HZ. Most (63.2%) HZ occurred within 6 months from onset of SLE or disease
flare-up. There was no significant difference in age of onset of SLE, gender,
disease duration, use of high dose steroid, or other immunosuppressive agents in 
patients with and without HZ. Patients with HZ were more likely to have prior or 
concurrent lupus nephritis (86.7%) than those without HZ (58.5%) (P = 0.096).
Occurrence of other major infections was also significantly more common in those 
who had HZ (80.0%) than those without (32.3%) (P = 0.006). CONCLUSIONS: Herpes
zoster was common in juvenile-onset SLE patients. Most were benign, without
systemic dissemination and postherpetic neuralgia. SLE patients with renal
involvement and heightened lupus activity were at greater risk of having HZ.
Those with HZ were also more likely to have other major infections during their
disease course.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16874173 [PubMed - indexed for MEDLINE]

431: Drugs Aging. 2006;23(6):525-31; discussion 532-3.

Zoster vaccine live (Oka/Merck).

Robinson DM, Perry CM.

Adis International Limited, Auckland, New Zealand. demail@adis.co.nz

A subcutaneously administered, live, high-titre (18,700-60,000 plaque-forming
units per dose) varicella zoster virus (VZV) vaccine (zoster vaccine) of the
Oka/Merck strain has been evaluated for the prevention of herpes zoster and the
reduction of zoster-associated pain in adults aged > or =60 years. Zoster
vaccine, when compared with placebo, reduced the burden of herpes zoster illness 
by 61%, the incidence of herpes zoster by 51% and the incidence of postherpetic
neuralgia by 67% during more than 3 years of surveillance. The zoster vaccine
caused an initial 1.7-fold rise in VZV antibody titre after 6 weeks that declined
progressively over 3 years. Increases in gamma-interferon-secreting peripheral
blood mononuclear cells were 2.2-fold greater with the zoster vaccine than with
placebo 6 weeks after vaccination. Zoster vaccine was generally well tolerated.
The most frequently reported adverse reactions following vaccination were
injection-site reactions; the only systemic adverse event with zoster vaccine
that differed significantly in incidence from that with placebo was headache.

Publication Types: 
    Review

PMID: 16872235 [PubMed - indexed for MEDLINE]

432: MMW Fortschr Med. 2006;Spec no.1:16.

[Two U.S. experts discuss the consequences of the "Shingles Prevention Study". Is
senior vaccination worthwhile in the practice?]

[Article in German]

[No authors listed]

PMID: 16872128 [PubMed - indexed for MEDLINE]

433: MMW Fortschr Med. 2006;Spec no.1:14-5.

[Study tests Varicella-Zoster vaccine for over 60-years-old persons. Protection
from Herpes zoster and postherpetic neuralgia]

[Article in German]

[No authors listed]

Publication Types: 
    Comparative Study

PMID: 16872127 [PubMed - indexed for MEDLINE]

434: MMW Fortschr Med. 2006;Spec no.1:7-12; quiz 13.

[Varicella-zoster virus infections--2: Zoster pain -- therapy and prevention]

[Article in German]

Wassilew SW.

Dermatologische Klinik, Klinikum Krefeld.
SWassilew.Dermatologie@klinikum-krefeld.de

Publication Types: 
    Comparative Study
    Review

PMID: 16872126 [PubMed - indexed for MEDLINE]

435: MMW Fortschr Med. 2006;Spec no.1:1-5; quiz 6.

[Varicella-zoster virus infections. 1: Chickenpox and shingles. Treatment and
prevention]

[Article in German]

Wassilew SW.

Dermatologische Klinik, Klinikum Krefeld.
SWassilew.Dermatologie@klinikum-krefeld.de

Publication Types: 
    Review

PMID: 16872125 [PubMed - indexed for MEDLINE]

436: Forsch Komplement Med (2006). 2006 Jun;13(3):184-6. Epub 2006 Jun 26.

[Recurrent herpes zoster with neuralgia]

[Article in German]

Schwickert M, Saha J.

Klinik fur Innere Medizin V / Naturheilkunde und Integrative Medizin, Kliniken
Essen-Mitte/ Knappschaftskrankenhaus, Essen, Deutschland.
myriam.schwickert@kliniken-essen-mitte.de

We present the case of a 40-year-old female patient suffering from recurrent
herpes zoster and postherpetic neuralgia. Herpes zoster has recurred several
times per year for more than 15 years. At admission, rash localised on the right 
sacral region and accompanied by neuralgia had lasted for 3 months. Standard
out-patient treatment remained unsuccessful. A multimodal integrative therapy
regimen including fasting, hydrotherapy, leech application and treatment with
autologous blood led to rapid healing of herpetic lesions and persistent pain
relief. The case is discussed.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16868364 [PubMed - indexed for MEDLINE]

437: Int J Hematol. 2006 Jul;84(1):79-82.

Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood 
transplantation for myelodysplastic syndrome-overt leukemia.

Fukuno K, Tomonari A, Takahashi S, Ooi J, Takasugi K, Tsukada N, Konuma T, Iseki 
T, Moriwaki H, Tojo A, Asano S.

Department of Hematology/Oncology, The Institute of Medical Science, The
University of Tokyo, Shirokanidae, Tokyo.

Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is
rare after hematopoietic stem cell transplantation (SCT). Here, we describe the
first patient who developed VZV encephalitis after cord blood transplantation
(CBT). A 35-year-old man with myelodysplastic syndrome-overt leukemia underwent
CBT. On day +23, a neutrophil count consistently greater than 0.5 x 10(9)/L was
achieved. On day +42, 1 mg/kg per day of prednisolone therapy was initiated for
grade III acute graft-versus-host disease (GVHD). Then, the dose of prednisolone 
was slowly reduced. For exacerbation of chronic GVHD, the dose of prednisolone
was again increased to 1 mg/kg per day on day +231. On day +265, localized
cutaneous zoster in the left thoracic region occurred, but soon resolved after
acyclovir therapy. On day +309, he suddenly developed diplopia. Subsequently,
right facial palsy and hearing impairment occurred. No skin rash was observed.
Magnetic resonance imaging (MRI) scans revealed multifocal abnormal high-signal
intensity in the CNS. A high level of VZV DNA was detected in a cerebrospinal
fluid specimen. He was diagnosed with VZV encephalitis. Acyclovir was given
intravenously for 40 days. Four months after the onset, the neurologic symptoms
had incompletely resolved. MRI scans showed substantial resolution but with mild 
residual lesions. The present report indicates that VZV should be considered as a
possible causative agent in patients who develop multifocal neurologic symptoms
of the CNS after SCT.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16867908 [PubMed - indexed for MEDLINE]

438: Australas J Dermatol. 2006 Aug;47(3):189-91.

Wolf's isotopic response: rosacea appearing at the site of healed herpes zoster.

Sezer E, Koseoglu RD, Filiz N.

Department of Dermatology, Gaziosmanpasa University Scholn of Medicine, Tokat,
Turkey. eseze@yahoo.com

A 40-year-old man developed an erythematous rash on the right side of his face 3 
weeks after a herpes zoster infection at the same location. Examination revealed 
an erythematous papular eruption and telangiectasias along the ophthalmic and
maxillary divisions of the right trigeminal nerve, exactly at the site of the
consistent with previous herpes zoster infection, Wolf's isotopic response.
Histological examination showed vascular ectatic dilatation and perivascular and 
perifollicular infiltration of lymphocytes and histiocytes consistent with
rosacea. The rash was resistant to oral doxycycline and topical metronidazole 1% 
cream and resolved with oral isotretinoin therapy.

Publication Types: 
    Case Reports

PMID: 16867001 [PubMed - indexed for MEDLINE]

439: Health News. 2006 Jul;12(7):5-6.

Easing the pain of shingles.

[No authors listed]

Publication Types: 
    News

PMID: 16858750 [PubMed - indexed for MEDLINE]

440: Breast J. 2006 Jul-Aug;12(4):385.

Ulcerative carcinoma of the breast with zosteriform skin metastases.

Torchia D, Palleschi GM, Terranova M, Antiga E, Melani L, Caproni M, Fabbri P.

Department of Dermatological Sciences, University of Florence, Florence, Italy.

Publication Types: 
    Case Reports

PMID: 16848856 [PubMed - indexed for MEDLINE]

441: J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):938-42. Epub 2006 Apr 25.

Comment in:
    J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):901.

Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal 
fluid from 34 patients with varicella-zoster virus infection of the nervous
system.

Gregoire SM, van Pesch V, Goffette S, Peeters A, Sindic CJ.

Department of Neurology, Universite catholique de Louvain, Cliniques
Universitaires Saint-Luc, Brussels, Belgium.

OBJECTIVE: To study cerebrospinal fluid (CSF) and serum samples from 34
consecutive patients suspected of having varicella-zoster virus (VZV) infection
of the central nervous system (CNS). Population and METHODS: The patients were
divided into three groups. The first group consisted of 27 patients with a rash
in one to three dermatomes and clinical suspicion of meningitis and radiculitis; 
among them, three subgroups were distinguished according to the affected
dermatome: ophthalmicus (n = 9), oticus (n = 11) and cervico-thoraco-lumbar
zoster (n = 7). Four cases of zoster sine herpete (ZSH) were included in the
second group: these patients presented with either radiculitis (n = 2) or
meningoencephalitis (n = 2), without cutaneous eruption. The third group
consisted of three patients with a generalised rash and encephalitis. A
polymerase chain reaction (PCR) for VZV DNA and antigen-driven immunoblots for
oligoclonal anti-VZV antibodies were carried out on all CSF samples. RESULTS: PCR
of the CSF was positive in 44% of the patients from the first group, mainly
within the first 7 days after eruption. In addition, intrathecal synthesis of
anti-VZV antibodies was detected in 37% of patients, always after an interval of 
7 days (p<0.0001). Among the four patients with ZSH, a positive VZV PCR was
detected in three patients and CSF-specific oligoclonal anti-VZV antibodies in
two. PCR was also positive in the CSF of two of the three patients with
generalised rash and encephalitis; local production of anti-VZV antibodies was
seen in a second CSF sample in one patient, and was also present in the third
patient. CONCLUSION: Amplification of VZV DNA by PCR in the CSF and
antigen-driven immunoblots have important diagnostic value in suspected VZV
infection, although their presence depends on the timing of the CSF sampling. VZV
is thought to be a causative agent in unexplained cases of meningitis associated 
with radiculitis or focal CNS symptoms, even in the absence of skin
manifestations. In such patients, rapid diagnosis by this combined approach
permits early antiviral treatment.

PMID: 16844949 [PubMed - indexed for MEDLINE]

442: Prim Dent Care. 2006 Jul;13(3):114-6.

Spontaneous tooth exfoliation, maxillary osteomyelitis and facial scarring
following trigeminal herpes zoster infection.

Pillai KG, Nayar K, Rawal YB.

SDM College of Dental Sciences and Hospital, Sattur, Dharwad, Karnataka, India.
gopal@trinidad.net

A case of trigeminal herpes zoster (HZ) infection affecting the left maxillary
and ophthalmic divisions of the fifth cranial nerve in an immuno-competent
patient is presented. Extremely rare complications such as osteonecrosis,
spontaneous tooth exfoliation, secondary osteomyelitis and facial scarring were
observed. Sequestrectomy, aciclovir and erythromycin stearate were effectively
used in managing the case.

Publication Types: 
    Case Reports

PMID: 16836817 [PubMed - indexed for MEDLINE]

443: JAMA. 2006 Jul 12;296(2):157-8.

FDA approves shingles vaccine: herpes zoster vaccine targets older adults.

Mitka M.

Publication Types: 
    News

PMID: 16835412 [PubMed - indexed for MEDLINE]

444: N Engl J Med. 2006 Jul 6;355(1):e1.

Images in clinical medicine. Abdominal pseudohernia due to herpes zoster.

Tagg NT, Tsao JW.

Walter Reed Army Medical Center, Washington, DC 20307, USA.

Publication Types: 
    Case Reports

PMID: 16822989 [PubMed - indexed for MEDLINE]

445: MMW Fortschr Med. 2006 Jun 1;148(22):53.

[Painful vesicles of the ear]

[Article in German]

Leunig A.

Oberarzt, Klinik und Poliklinik fur Hals-Nasen-Ohren-Heilkunde der
Ludwig-Maximilians-Universitat Munchen.

Publication Types: 
    Case Reports

PMID: 16821584 [PubMed - indexed for MEDLINE]

446: Altern Med Rev. 2006 Jun;11(2):102-13.

Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic
considerations.

Roxas M.

Thorne Research, PO Box 25, Dover, ID 83825, USA. m.roxas@comcast.net.

Herpes zoster (HZ), also known as shingles, is a painful vesicular rash resulting
from reactivation of the virus that also causes chickenpox - Varicella zoster
virus (VZV). Typically, the rash runs its course in a matter of 4-5 weeks. The
pain, however, may persist months, even years, after the skin heals. This
phenomenon is known as postherpetic neuralgia (PHN). Often described as an
intense burning, itching sensation, this pain can be significant to the point of 
being debilitating, and as such can greatly affect quality of life. Although
shingles is generally regarded as a self-limited condition, the fact it can take 
several weeks to resolve and has the potential for development of complications
such as PHN presents a challenge to clinicians. Many treatment options are
available, each offering variable levels of efficacy. Conventional therapies
include prescription antivirals, corticosteroids, and analgesics, both oral and
topical. Other considerations include use of over-the-counter anti-inflammatory
agents, physiotherapy, and nerve block injections. This article reviews herpes
zoster and postherpetic neuralgia, and presents the most effective conventional
treatment options currently available, as well as select botanical, nutritional, 
and other considerations that may be beneficial in the management of this
condition.

Publication Types: 
    Review

PMID: 16813460 [PubMed - indexed for MEDLINE]

447: Acta Haematol. 2006;116(1):58-61.

Acute abdomen by varicella zoster virus induced gastritis after autologous
peripheral blood stem cell transplantation in a patient with non-Hodgkin's
lymphoma.

Scholl S, Hocke M, Hoffken K, Sayer HG.

Department of Internal Medicine II
(Oncology/Hematology/Gastroenterology/Infectious Disease), Medical Faculty,
Friedrich Schiller University, Jena, Germany. sebastian.scholl@med.uni-jena.de

We report on a 54-year-old male patient with an aggressive T cell non-Hodgkin's
lymphoma with abdominal manifestation undergoing autologous peripheral blood stem
cell transplantation after high-dose chemotherapy in April 2003. About 4 months
after transplantation, he developed severe upper abdominal pain. Ultrasound
examination, X-ray, computed tomography of the abdomen and cardiac diagnostics
could not explain the symptoms. While empiric therapy with high-dose acyclovir
was started, we could document herpetic lesions in the gastric antrum by
endoscopy. The epigastric pain rapidly decreased within several days after the
start of acyclovir therapy. No herpetic skin lesions were observed at any time
during the disease. This report demonstrates the importance of viral-induced
gastritis in the differential diagnosis of severe abdominal pain in patients
receiving autologous peripheral blood stem cell transplantation.

Publication Types: 
    Case Reports

PMID: 16809891 [PubMed - indexed for MEDLINE]

448: Acta Virol. 2006;50(2):121-8.

JC polyomavirus reactivation is not associated with herpes zoster.

Jeong BH, Park SJ, Koo DW, Kim YS.

Ilsong Institute of Life Science, Hallym University, Kyonggi-do, South Korea.

Herpes zoster (HZ) is a neurocutaneous disease caused by Varicella-zoster virus
(VZV) as a consequence of declined cell-mediated immunity, immune suppression and
immunodeficiency. As reactivation of JC polyomavirus (JCPyV) might be linked with
immunodeficiency or immunosuppressive therapy, the relationship between HZ and
JCPyV reactivation was investigated. The incidence of JCPyV in urine samples from
102 patients with HZ and 100 healthy individuals from South Korea was determined 
by PCR. The incidence values for HZ patients and control individuals did not
differ significantly (24.5% vs. 20.0%, respectively, P = 0.5391). When different 
age groups were monitored, the positivity values of 21.1%, 20.0%, and 30% were
found for 20-39, 40-59 and over 60 year-old patients, respectively. In order to
determine the genotype of JCPyV isolates, their VP1-large T antigen
(VT)-intergenic region was PCR amplified, sequenced and analyzed. Three distinct 
types, namely 1, 2A and 7B were found in 8%, 24%, and 68% of were found among 25 
isolates from HZ patients. Using phylogenetic analysis, the type 1 isolates were 
assigned to the 1C subtype. These results indicate that HZ does not play an
important role in JCPyV reactivation and is not associated with JCPyV.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16808330 [PubMed - indexed for MEDLINE]

449: Acta Neurochir (Wien). 2006 Aug;148(8):839-43; discussion 843. Epub 2006 Jun
29.

Frequency and prognosis of delayed facial palsy after microvascular decompression
for hemifacial spasm.

Rhee DJ, Kong DS, Park K, Lee JA.

Deparment of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School
of Medicine, Seoul, Korea.

BACKGROUND: Microvascular decompression (MVD) for hemifacial spasm (HFS) provides
a long-term cure rate. Delayed facial palsy (DFP) is not an unusual complication,
but it has only been sporadically described in the literature. The purpose of
this report is to evaluate the incidence of delayed facial palsy after MVD and
its clinical course and final results. METHODS: From January, 1998 to April,
2004, 410 patients underwent microvascular decompression for hemifacial spasm at 
our Institute. During this time, 21 patients (5.4%) developed delayed facial
weakness; eighteen of them were given steroid medication and they were followed
up in the out-patient clinic. FINDINGS: Twenty-one patients developed DFP after
microvascular decompression an incidence of 5.4%. There were seventeen women
(81.0%) among the 21 patients with DFP who were included in this study. In twenty
of them, the symptoms of HFS improved completely after the operation, but the
spasm remained with one of them. The onset of palsy occurred between
postoperative day 7 and 23 (average: 12.1 days). The palsy was at least Grade II 
or worse on the House-Brackmann (HB) scale. The time to recovery averaged 5.7
weeks (range: 25 days-17 weeks); 20 patients improved to complete recovery and 1 
patient remained with minimal weakness, as Grade II on the HB scale, at the
follow-up examination. CONCLUSION: Our findings demonstrated that the incidence
of DFP was not so low as has been reported the literature, and it did not have
any striking predisposing factors. Even though the degree of facial palsy was
variable, almost all patients exhibited a complete recovery without any further
special treatment. The etiology of DFP and its association with herpes infection 
should be further clarified.

PMID: 16804640 [PubMed - indexed for MEDLINE]

450: Anaesth Intensive Care. 2006 Jun;34(3):382-3.

Development of bilateral herpes zoster following thoracoscopic splanchnicectomy.

Brandon EL, Akers J, Rapeport D.

Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Western
Australia.

A 39-year-old female presented for elective bilateral thoracoscopic
splanchnicectomy for chronic severe visceral pain. Surgery and anaesthesia were
uneventful and she gained good symptomatic relief. Postoperative recovery was
complicated by the development on day four of bilateral herpes zoster at the T8
dermatome level. This was treated immediately with oral acyclovir. She
subsequently developed severe post-herpetic neuralgia requiring the
recommencement of gabapentin and amitriptyline. Further benefit was gained from a
course of calcitonin. This case report examines the possible causative factors in
the development of post-surgical herpes zoster.

Publication Types: 
    Case Reports

PMID: 16802497 [PubMed - indexed for MEDLINE]

451: Actas Dermosifiliogr. 2006 Apr;97(3):206-7.

[Cutaneous metastases of rectal adenocarcinoma in a herpetiform distribution]

[Article in Spanish]

Torne J, Bonaut B, Sanz C, Martinez C, Torrero MV, Miranda-Romero A.

Servicio de Dermatologia, Hospital Clinico Universitario, Valladolid, Espana.
itorne@aedv.es

We present the case of a 62-year-old male with cutaneous metastases of a rectal
adenocarcinoma located on the groin and left thigh. Due to their clinical
similarity, the lesions were initially diagnosed and treated as herpes zoster.
Cutaneous metastases have variable clinical presentation patterns. They may mimic
benign skin lesions like epidermoid cysts, lipomas, erysipelas or, as in our
case, herpes zoster.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16796970 [PubMed - indexed for MEDLINE]

452: Rev Med Virol. 2006 Jul-Aug;16(4):225-50.

Molecular studies of Varicella zoster virus.

Quinlivan M, Breuer J.

Centre for Infectious Diseases, Institute for Cell and Molecular Science, 4
Newark Street, Whitechapel, London, E1 2AT, UK. m_quinlivan@hotmail.com

VZV is a highly cell-associated member of the Herpesviridae family and one of the
eight herpesviruses to infect humans. The virus is ubiquitous in most populations
worldwide, primary infection with which causes varicella, more commonly known as 
chickenpox. Characteristic of members of the alphaherpesvirus sub-family, VZV is 
neurotropic and establishes latency in sensory neurones. Reactivation from
latency, usually during periods of impaired cellular immunity, causes herpes
zoster (shingles). Despite being one of the most genetically stable human
herpesviruses, nucleotide alterations in the virus genome have been used to
classify VZV strains from different geographical regions into distinct clades.
Such studies have also provided evidence that, despite pre-existing immunity to
VZV, subclinical reinfection and reactivation of reinfecting strains to cause
zoster is also occurring. During both primary infection and reactivation, VZV
infects several PBMC and skin cell lineages. Difficulties in studying the
pathogenesis of VZV because of its high cell association and narrow host range
have been overcome through the development of the VZV severe combined
immunodeficient mouse model carrying human tissue implants. This model has
provided a valuable tool for studying the importance of individual viral proteins
during both the complex intracellular replication and assembly of new virions and
for understanding the underlying mechanism of attenuation of the live varicella
vaccine. In addition, a rat model has been developed and successfully used to
uncover which viral proteins are important for both the establishment and
maintenance of latent VZV infection.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16791838 [PubMed - indexed for MEDLINE]

453: Euro Surveill. 2005 Jun 9;10(6):E050609.4.

Research shows that highly potent vaccine reduces the burden of herpes zoster and
the incidence of postherpetic neuralgia in older adults.

Ciancio BC.

European Programme Intervention Epidemiology Training (EPIET), London, England.
bruno.ciancio@hpa.org.uk

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16783098 [PubMed - indexed for MEDLINE]

454: Beijing Da Xue Xue Bao. 2006 Jun 18;38(3):324-5.

[Rheumatoid leptomeningitis: a case report and literature review]

[Article in Chinese]

Zheng RL, Lv H, Zhang W, Yu MX, Yuan Y.

Department of Neurology, Peking University First Hospital, Beijing 100034, China.

To report the clinical, radiological and neuropathological findings of a patient 
with rheumatoid meningitis. The patient was a 71-year-old Chinese man with a
two-year history of rheumatoid arthritis and no other significant medical
history, who presented to our hospital recurrent weakness of his left
extremities, dysarthria and a continuous bilateral hand tremor. Cerebrospinal
fluid (CSF) and serum examinations were normal apart from a mildly raised serum
perinuclear antineutrophil cytoplasmic autoantibody (p-ANCA). Brain magnetic
resonance imaging (MRI) showed leptomeningeal enhancement in both frontal and
parietal lobes, in addition to several old white matter infarcts. Meningeal
biopsy showed numerous infiltrating macrophages and lymphocytes within the
leptomeninges. The patient responded clinically and radiologically to
corticosteroid and cyclophosphamide therapy. The patient subsequently developed
herpes zoster over his left chest as a complication of his immunosuppressive
treatment. His cyclophosphamide was ceased and intravenous immunoglobulin (IVIG) 
therapy was commenced, with good clinical response to both the herpes zoster and 
meningitis. According to the result of the biopsy, aseptic meningitis was
considered the MRI results and the patient's clinical history were given, and a
diagnosis of rheumatoid meningitis was made. The patient was p-ANCA positive.
Although there was no evidence for cerebral vasculitis on biopsy, it remains a
possibility that the patient's recurrent minor cerebral infarcts visible on MRI
were vasculitic in nature.

Publication Types: 
    English Abstract

PMID: 16778982 [PubMed - in process]

455: J Spinal Disord Tech. 2006 Jun;19(4):299-301.

Herpes zoster--varicella complicating anterior thoracic surgery: 2 case reports.

Godfrey EK, Brown C, Stambough JL.

University of Cincinnati College of Nursing, Cincinnati, OH, USA.

This article reviews the reactivation of the latent varicella-zoster virus
infection within the sensory dorsal root ganglia resulting in shingles. Although 
the association between surgery and reactivation of the varicella-zoster virus is
known, we feel it is important to keep the diagnosis of shingles in mind
especially in a patient with sudden onset of increased pain after surgery. Our
purpose is to report 2 rare clinical presentations of shingles after spinal
surgery in which the patient's initial diagnosis was not clear until the
classical rash was observed. Two case reports are presented in which 1 patient
developed shingles 5 days after surgery with distribution of the maculopapular
rash in a surgical incision, whereas the second patient did not present until 4
weeks after surgery with a disseminated picture. Early recognition of this
postoperative problem is imperative for prompt and appropriate management, as
misdiagnosis can lead to short-term and long-term pain control issues,
postherpetic neuralgia, neuropathic pain, or other related sequelae.

Publication Types: 
    Case Reports

PMID: 16778668 [PubMed - indexed for MEDLINE]

456: Am J Dermatopathol. 2006 Jun;28(3):194-6.

Nodular herpes zoster with herpetic syringitis and no epidermal involvement in a 
patient with Burkitt lymphoma.

Alonso-Perez A, Fraga J, Delgado Y, Aragues M, Nam-Cha S, Garcia-Diez A.

Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain. 
palomalav@yahoo.es

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.

Publication Types: 
    Case Reports

PMID: 16778483 [PubMed - indexed for MEDLINE]

457: Med Trop (Mars). 2006 Apr;66(2):167-71.

[Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation
in Libreville, Gabon]

[Article in French]

Okome-Nkoumou M, Boguikouma JB, Kombila M.

Departement de medecine interne et specialites medicales, Universite des Sciences
de la Sante , Libreville, Gabon. okomem@hotmail.com

The purpose of this study was to determine the frequencies of opportunistic
diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, 
Gabon. A total 6313 file of patients treated in the internal medicine unit
between 1994 and 1998 were analyzed. Findings showed that the main diseases
related to AIDS classified according to seroprevalence were as follows: purigo
(100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia
(87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main
diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid
(9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%),
and malaria (14%). In addition to these diseases there were nine cases of
Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two
cases of herpes Varicella, one case of cryptosporidiosis, and one case of
isosporosis. The incidence of opportunistic disease was high in our study and
must be taken in drug procurement.

Publication Types: 
    English Abstract

PMID: 16775941 [PubMed - indexed for MEDLINE]

458: J Ayub Med Coll Abbottabad. 2006 Jan-Mar;18(1):64-5.

Simultaneous onset of herpes zoster in a father and son.

Raza N, Dar NR, Ejaz A.

Department of Dermatology, Combined Military Hospital, Abbottabad.
naeemraza561@hotmail.com

The Varicella Zoster virus persists in sensory nerve ganglion cells after chicken
pox and gets reactivated to cause herpes zoster after variable periods of time as
a result of waning of specific cellular immunity. Susceptible contacts of herpes 
zoster can develop chicken pox and very rarely herpes zoster. We report an
interesting case of a father and his son who developed herpes zoster
simultaneously without any obvious common predisposition and discuss the possible
underlying mechanism.

Publication Types: 
    Case Reports

PMID: 16773975 [PubMed - indexed for MEDLINE]

459: Expert Rev Anti Infect Ther. 2006 Jun;4(3):367-76.

Valacyclovir for the treatment of genital herpes.

Brantley JS, Hicks L, Sra K, Tyring SK.

The University of Texas Medical Branch, Department of Dermatology, 301 University
Boulevard, Galveston, TX 77555-0783, USA. jsbrantl@utmb.edu

Genital herpes is the most prevalent sexually transmitted infection in the USA.
While sometimes mild in severity, it can be a distressing and painful chronic
condition. Likewise, herpes labialis and herpes zoster can be both physically and
psychologically painful. While there is no cure for these conditions, treatment
to alleviate symptoms, suppress recurrences and reduce transmission has been
drastically improved over the past 20 years with the use of guanine nucleoside
antivirals, such as valacyclovir hydrochloride (Valtrex), GlaxoSmithKline) the
highly bioavailable prodrug of acyclovir (Zovirax((R)), GlaxoSmithKline), and
famciclovir (Famvir, Novartis), a highly bioavailable prodrug of penciclovir
(Denavir, Novartis). Clinical trials involving approximately 10,000 patients
(including patients from nongenital herpes studies, such as herpes zoster) have
assessed the safety and efficacy of valacyclovir in the treatment of initial
genital herpes outbreaks, episodic treatment of recurrent episodes and daily
suppressive therapy. It was shown that valacyclovir has similar efficacy to
acyclovir in the episodic and suppressive treatment of genital herpes.
Valacyclovir is the only antiviral drug approved for a once-daily dose of
suppressive therapy for genital herpes, as well as the only antiviral drug US FDA
approved for a 3-day regimen of episodic treatment of recurrent genital herpes.
In addition, valacyclovir is also indicated in the reduction of the sexual
transmission of herpes simplex virus infection and for the treatment of herpes
labialis. In herpes zoster, valacyclovir is more effective than acyclovir or
placebo (and as equally effective as famciclovir) in shortening the length and
severity of herpes zoster-associated pain and postherpetic neuralgia.
Valacyclovir has an acceptable safety profile in patients with herpes simplex and
herpes zoster. The less frequent dosing regimen makes it an attractive option in 
the treatment of genital herpes and other viral infections, and may contribute to
increased patient adherence to therapy.

Publication Types: 
    Review

PMID: 16771614 [PubMed - indexed for MEDLINE]

460: Hernia. 2006 Aug;10(4):364-6; discussion 293. Epub 2006 Jun 13.

Abdominal-wall postherpetic pseudohernia.

Oliveira PD, dos Santos Filho PV, de Menezes Ettinger JE, Oliveira IC.

Department of Surgery, Escola Bahiana de Medicina e Saude Publica, Salvador,
Bahia, Brazil. pedroebm@gmail.com

Herpes zoster affects 10-20% of the general population. Motor complications
sometimes occur in the segments corresponding to the involved sensory dermatomes 
causing abdominal wall pseudohernias. We present a case of a 57-year-old woman
with herpes zoster characteristical rash following T11-T12 right dermatomes. Ten 
days after dermatologic manifestations onset, she had developed a protrusion at
the abdominal wall on the right flank. The electroneuromyography confirmed axonal
motor commitment, and morphological defects were ruled out by ultrasonography.
The bulge totally disappeared after 4 months of observation. Postherpetic
pseudohernia must be suspected when a patient develops signs and symptoms of
motor dysfunction that coincide with or follow a herpes zoster eruption resulting
in abdominal-wall herniation. A review of the literature concerning these
extremely exceptional sequelae of herpes zoster is presented.

Publication Types: 
    Case Reports

PMID: 16770518 [PubMed - indexed for MEDLINE]

461: Cardiology. 2007;107(1):63-7. Epub 2006 Jun 7.

Herpes zoster and its cardiovascular complications in the elderly--another look
at a dormant virus.

Ma TS, Collins TC, Habib G, Bredikis A, Carabello BA.

Section of Cardiology, Department of Medicine, Michael E. DeBakey VA Medical
Center and Baylor College of Medicine, Houston, TX 77030, USA. tma@bcm.tmc.edu

Herpes zoster (shingles) is a reactivation of latent Varicella-zoster virus
(VZV). We present a case of pleuropericarditis simulating acute myocardial
infarction and another with complete heart block in the setting of acute/recent
VZV reactivation. These cases are consistent with a modified concept: (1) the VZV
dormancy is comprised of multiple foci of infections in the sensory and autonomic
ganglia, and (2) the VZV reactivation could involve co-incident activations of
two or more loci. Recognition of this possibility of cardiovascular complications
of VZV should be helpful in the clinical management of the elderly, in the
differential diagnosis of chest pain, ST elevation, and heart block etiology in
the setting of acute or recent VZV reactivation.

Publication Types: 
    Case Reports

PMID: 16763386 [PubMed - indexed for MEDLINE]

462: Dent Update. 2006 May;33(4):252.

Comment in:
    Dent Update. 2006 Jul-Aug;33(6):378.

Physical signs for the general dental practitioner.

Bain S.

University of Wales, Swansea.

PMID: 16756242 [PubMed - indexed for MEDLINE]

463: Epidemiol Infect. 2007 Jan;135(1):131-8. Epub 2006 Jun 2.

Epidemiology of hospital admissions for paediatric varicella infections: a
one-year prospective survey in the pre-vaccine era.

Dubos F, Grandbastien B, Hue V; Hospital Network for Evaluating Management of
Common Childhood Diseases, Martinot A.

Paediatric Emergency Department, Jeanne de Flandre University Hospital, Lille,
France.

To evaluate the epidemiology of hospital admissions for varicella in children, a 
1-year prospective multicentre study was done in Northern France in the
pre-varicella vaccine era. The 405 children aged <16 years seen at local
hospitals for varicella or herpes zoster were included. Among them, 143 who had
varicella and resided in the district were admitted. Admission incidence rates
were 28/100000 children aged <16 years (149/100000 infants aged <1 year,
69/100000 children aged 1-4 years, and 2/100000 children aged 5-15 years). Most
admissions (57%) were related to complications, usually skin infection (47%).
Independent risk factors for admission were place of residence outside the
district [adjusted odds ratio (aOR) 8.7], complication at admission (aOR 5.8),
recurrent fever (aOR 4.5), recent varicella in a sibling (aOR 4.0), and previous 
physician visit for the same condition (aOR 2.0).

Publication Types: 
    Multicenter Study

PMID: 16740185 [PubMed - indexed for MEDLINE]

464: Exp Hematol. 2006 Jun;34(6):770-5.

Bortezomib after dose-reduced allogeneic stem cell transplantation for multiple
myeloma to enhance or maintain remission status.

Kroger N, Zabelina T, Ayuk F, Atanackovic D, Schieder H, Renges H, Zander A.

Department of Bone Marrow Transplantation, Transplant Center, University Medical 
Center Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de

OBJECTIVE: We investigated the effect of at least two cycles of bortezomib (1.3
mg/m(2) intravenously, days 1, 4, 8, and 11) after dose-reduced allogeneic stem
cell transplantation (SCT) on toxicity, CD3(+) cells, graft-versus-host disease
(GvHD), and response in patients with multiple myeloma. METHODS: Eighteen
patients with multiple myeloma without progressive disease were included. The
proteasome inhibitor was given at median of 8 months after allografting to
enhance or maintain remission status. RESULTS: Fourteen patients (78%) completed 
the proposed two cycles. Four patients had to discontinue therapy due to
neurotoxicity (n = 3) or gastrointestinal toxicity (n = 1). Severe grade III/IV
toxicity was seen for thrombocytopenia (50%), leukopenia (17%), or neuropathy
(17%), which was more often seen in patients treated concomitantly with
cyclosporine (p = 0.06). The median circulating CD3(+) cells decreased during
treatment from 550 muL to 438 muL (p = 0.03), resulting in herpes zoster
infection in three patients (17%). In three patients, a mild aggravation of
existing acute or chronic GvHD of the skin, and in one patient de novo skin grade
I acute GvHD was noted. In patients with measurable disease, complete remission, 
partial remission, and minor response was seen in 3 (30%), 5 (50%), and 2 (20%)
patients, respective. CONCLUSION: Bortezomib after allogeneic SCT is effective
but further studies are needed to balance the efficacy with potential hazards
such as infectious complications, aggravation of GvHD, and neurotoxicity.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 16728282 [PubMed - indexed for MEDLINE]

465: J Pediatr (Rio J). 2006 Jul;82(3 Suppl):S115-24. Epub 2006 May 19.

Vaccines under development: group B streptococcus, herpes-zoster, HIV, malaria
and dengue.

da Silva LJ, Richtmann R.

Diciplina de Infectologia, Departamento de clinica Medica, Universidade Estadual 
de Campinas (UNICAMP), Campinas, SP, Brazil. ljsilva@unicamp.br

OBJECTIVES: To review the current state of development of streptococcus B,
herpes-zoster, HIV, malaria and dengue vaccines. These vaccines were selected
both because of imminent commercial release and because of specific problems with
their development. SOURCES OF DATA: A review of the literature was performed by
means of a MEDLINE search, on the period 1996 to 2006, for the epidemiology and
immunology of these diseases, analyzing both the greatest obstacles to creating a
vaccine and the current state of research, with emphasis on studies in the most
advanced stages. SUMMARY OF THE FINDINGS: Each of the five diseases chosen
presents specific problems for vaccine development. Nevertheless, in the majority
of cases these have been or are in sight of being resolved, allowing for the
prediction that a safe and effective vaccine - or vaccines - will be available in
the near future. CONCLUSIONS: Despite the problems faced in developing these
vaccines, advances in molecular biology and immunology have made it possible to
overcome most obstacles, opening up the prospects for new vaccines.

Publication Types: 
    Review

PMID: 16721441 [PubMed - indexed for MEDLINE]

466: Bone Marrow Transplant. 2006 Jul;38(1):41-6. Epub 2006 May 22.

Clinical relevance of quantitative varicella-zoster virus (VZV) DNA detection in 
plasma after stem cell transplantation.

Kalpoe JS, Kroes AC, Verkerk S, Claas EC, Barge RM, Beersma MF.

Department of Medical Microbiology, Leiden University Medical Center, Leiden, The
Netherlands.

Detection of Varicella-Zoster virus (VZV) DNA in plasma can facilitate the early 
recognition of complicated VZV-infection in immunocompromised hosts. The
correlation of VZV-DNA in plasma with clinical presentations of VZV-infection and
subsequent aciclovir treatment in allogeneic stem cell transplant (allo-SCT)
recipients was studied. In 81 consecutive VZV-IgG positive allo-SCT recipients,
VZV-DNA was measured at regular time points (1, 2 and 4 months) following
allo-SCT and patient records were screened for VZV-related symptoms and aciclovir
treatment. Subsequently, possible VZV-cases were studied in detail for the course
of VZV-DNA and treatment effects. During the initial screening, VZV-DNA was
detectable in seven patients. The survey of VZV-related symptoms revealed five
additional possible VZV-cases. In cases where suitable plasma samples were
available (10 out of 12), VZV-DNA was present almost simultaneously with the
first clinical manifestations. No evidence of a preceding phase detectable by
VZV-DNA only could be observed. Treatment with aciclovir was associated with a
prompt reduction of VZV-DNA load. Detection of VZV-DNA in plasma in allo-SCT
recipients accurately reflected the clinical presentation of VZV-infection and
treatment with aciclovir. VZV-DNA detection in plasma of allo-SCT recipients
appears clinically relevant as this may support early recognition and therapeutic
management of VZV-infections following allo-SCT.

PMID: 16715108 [PubMed - indexed for MEDLINE]

467: Ann Emerg Med. 2006 Jun;47(6):579, 584. Epub 2006 Feb 2.

Images in emergency medicine. Ramsay Hunt syndrome: a rare entity.

Bhagra A, Stead LG.

Mayo Clinic, Rochester, MN, USA.

Publication Types: 
    Case Reports

PMID: 16713790 [PubMed - indexed for MEDLINE]

468: Pain Med. 2006 May-Jun;7(3):243-9; discussion 250.

Postherpetic pain: more than sensory neuralgia?

Weiner DK, Schmader KE.

Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15206,
USA. dweiner@pitt.edu

OBJECTIVE: To describe a series of older adult patients with postherpetic
myofascial pain, a heretofore rarely described complication of herpes zoster.
DESIGN: Case series. SETTING: Outpatient older adult pain clinic. PATIENTS: Five 
older adults are presented with myofascial pain that developed as a complication 
of herpes zoster. RESULTS: Pain duration at the time of presentation ranged from 
4 months to 7 years. All patients reported functional impairment from pain
despite oral analgesics. Myofascial pathology was diagnosed by the presence of
taut bands and trigger points in the affected myotome. Upon successful treatment 
of the myofascial pain with nonpharmacologic modalities (e.g., physical therapy, 
trigger point injections, dry needling, and/or percutaneous electrical nerve
stimulation), all patients reported symptomatic improvement, and four out of five
were able to significantly reduce or discontinue their opioids. CONCLUSION:
Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon.
Identification of the intrusion of a myofascial component may be worthwhile, both
from the standpoint of enhanced pain relief and reduction in the need for oral
analgesics. Formal exploration of this phenomenon is needed.

Publication Types: 
    Case Reports

PMID: 16712624 [PubMed - indexed for MEDLINE]

469: Cutis. 2006 Apr;77(4):208.

Two ounces of prevention.

Weinberg JM.

Publication Types: 
    Editorial

PMID: 16706234 [PubMed - indexed for MEDLINE]

470: J Plast Reconstr Aesthet Surg. 2006;59(2):206-7.

An unusual cause of trismus: Ramsay Hunt syndrome.

Akyol A, Kiylioglu N, Copcu E.

Publication Types: 
    Case Reports
    Letter

PMID: 16703870 [PubMed - indexed for MEDLINE]

471: Eur J Epidemiol. 2006;21(6):469-73. Epub 2006 May 16.

Impact of CCR5 Delta32/+ deletion on herpes zoster among HIV-1-infected
homosexual men.

Krol A, Lensen R, Veenstra J, Prins M, Schuitemaker H, Coutinho RA.

Department of Research, Health Service of Amsterdam, Cluster, Infectious
Diseases, Amsterdam, The Netherlands. akrol@ggd.amsterdam.nl

The association between the presence of CCR5 Delta32 heterozygosity and incidence
of clinical herpes zoster was studied among 296 homosexual men from the Amsterdam
cohort study (ACS) infected with human immunodeficiency virus type I (HIV-1) with
an estimated date of seroconversion. Of them 63 were CCR5 Delta32 heterozygotes
and 233 CCR5 wild-type. The incidence rate of a first episode of herpes zoster
was 4.2% and 5.3% per person-year, respectively. A higher occurrence of herpes
zoster was strongly related to a lower CD4 + cell count. After adjustment for
age, presence of CCR2b 64I heterozygosity, HIV RNA load, time since
seroconversion, and CD4 + cell count, the rate ratio for herpes zoster of CCR5
Delta32 was 0.9 (95%CI 0.5-1.6). In conclusion, in HIV-1-infected homosexual men,
a CCR5 Delta32 heterozygous genotype has no protective effect on the incidence of
herpes zoster.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16703416 [PubMed - indexed for MEDLINE]

472: Drugs Today (Barc). 2006 Apr;42(4):249-54.

Varicella-zoster virus vaccine: a review of its use in the prevention of herpes
zoster in older adults.

Caple J.

Medical Information Department, Prous Science, Barcelona, Spain.
journals@prous.com

Current strategies for managing herpes zoster show variable efficacy and do not
prevent its appearance. Varicella-zoster virus vaccine, or "zoster vaccine" is a 
more potent form of the varicella-zoster virus vaccine currently approved for use
in the prevention of varicella in children. Zoster vaccine decreases the
incidence of herpes zoster and burden of illness in adults aged 60 years and
older and appears more efficacious in patients aged 60-69 than in those over 70
years. Importantly, the incidence of postherpetic neuralgia is significantly
reduced in patients who receive zoster vaccine, irrespective of age or sex. The
duration of postherpetic neuralgia is also significantly reduced. Zoster vaccine 
has a favorable safety profile; most treatment-related adverse events are related
to the site of injection. This review summarizes the current data on the clinical
efficacy and safety of zoster vaccine in adults aged 60 years and older.
Copyright (c) 2006 Prous Science. All rights reserved.

Publication Types: 
    Review

PMID: 16703121 [PubMed - indexed for MEDLINE]

473: Acta Otolaryngol. 2006 May;126(5):460-6.

Inner ear and facial nerve complications of acute otitis media with focus on
bacteriology and virology.

Hyden D, Akerlind B, Peebo M.

Department of Otolaryngology, Linkoping University Hospital, Linkoping, Sweden.
dag.hyden@lio.se

CONCLUSION: Among 20 patients with inner ear complications and/or peripheral
facial palsy secondary to acute otitis media (AOM) a proven or probable
bacteriological cause was found in 13 (65%). In seven patients (35%), a proven or
probable viral cause was found. Only two of the patients (10%), with a proven
bacterial AOM and a clinical picture of a purulent labyrinthitis in both,
together with a facial palsy in one, had a substantial degree of dysfunction.
Although the number of patients in this study is relatively low our findings show
that inner ear complications and facial palsy due to AOM can be of both bacterial
and viral origin. Severe sequelae were found only where a bacterial origin was
proven. OBJECTIVES: Inner ear complications and/or peripheral facial palsy
secondary to AOM are rare. The general understanding is that they are due to
bacterial infections. However, in some of these patients there are no clinical or
laboratory signs of bacterial infections and they have negative bacterial
cultures. During recent years different viruses have been isolated from the
middle ear or serologically proven in AOM patients and are thought to play a
pathogenetic role. We suggest that in some cases of AOM complications from the
inner ear and the facial nerve can be caused by viruses. The purpose of our study
was to analyze infectious agents present in patients with inner ear complications
and/or facial palsy arising from AOM. PATIENTS AND METHODS: The medical records
of 20 patients who had inner ear complications and/or facial palsy following AOM 
( unilateral in 18, bilateral in 2) between January 1989 and March 2003 were
evaluated. Bacterial cultures were carried out for all patients. Sera from 12 of 
the patients were stored and tested for a battery of specific viral antibodies.
In three patients, investigated between November 2002 and March 2003, viral
cultures were also performed on samples from the middle ear and nasopharynx.
RESULTS: Nineteen patients had inner ear symptoms. Eight of them had a unilateral
sensorineural hearing loss and vertigo, three had vertigo as an isolated symptom 
and one, with bilateral AOM, had bilateral sensorineural hearing loss. Seven
patients had a combination of facial palsy and inner ear symptoms (unilateral
sensorineural hearing loss in three, unilateral sensorineural hearing loss and
vertigo in two, bilateral sensorineural hearing loss and vertigo in one, with
bilateral AOM, and vertigo alone in one). One patient had an isolated facial
palsy. Healing was complete in 11 of the 20 patients. In seven patients a minor
defect remained at follow-up (a sensorineural hearing loss at higher frequencies 
in all). Only two patients had obvious defects (a pronounced hearing loss in
combination with a moderate to severe facial palsy (House-Brackman grade 4) in
one, distinct vestibular symptoms and a total caloric loss in combination with a 
high-frequency loss in the other. Eight patients had positive bacteriological
cultures from middle ear contents: Streptococcus pneumoniae in two,
beta-hemolytic Streptococcus group A in two, beta-hemolytic Streptococcus group A
together with Staphylococcus aureus in one, Staph. aureus alone in one and
coagulase-negative staphylococci (interpreted as pathogens) in two. In the 12
patients with negative cultures, there was a probable bacteriological cause due
to the outcome in SR/CRP and leukocyte count in five. In four patients
serological testing showed a concomitant viral infection that was interpreted to 
be the cause (varicella zoster virus in two, herpes simplex virus in one and
adenovirus in one.) In three there was a probable viral cause despite negative
viral antibody test due to normal outcome in SR/CRP, normal leukocyte count,
serous fluid at myringotomy and a relatively short pre-complication antibiotic
treatment period.

PMID: 16698694 [PubMed - indexed for MEDLINE]

474: Acta Otorrinolaringol Esp. 2006 Apr;57(4):189-92.

[Varicella-zoster infection with isolated cochleovestibular affectation (without 
facial palsy)]

[Article in Spanish]

Gundin G, Monedero G, Teba JM, Perez Esteban L, Sanz R.

Servicio de Otorrinolaringologia, Hospital Universitario de Getafe, Madrid.

Otological complications of Ramsay Hunt syndrome include facial paralysis,
tinnitus, hearing loss, vertigo, dysgeusia, and skin eruption. The lower cranial 
nerves sometimes are affected by this neuritis. A case is reported of a man
without immune-system impairment who had a cranial mononeuritis with unilateral
involment of the VIII and VII cranial nerves after infection with
varicella-zoster without herpetic lesions.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16686230 [PubMed - indexed for MEDLINE]

475: Arch Neurol. 2006 Jul;63(7):940-2. Epub 2006 May 8.

Improvement of postherpetic neuralgia after treatment with intravenous acyclovir 
followed by oral valacyclovir.

Quan D, Hammack BN, Kittelson J, Gilden DH.

Department of Neurology, University of Colorado Health Sciences Center, Denver,
Colorado 80262, USA.

BACKGROUND: Postherpetic neuralgia (PHN) is a complication of shingles (herpes
zoster), a painful rash due to varicella-zoster virus reactivation. Studies of
patients with PHN and zoster sine herpete (radicular pain without rash) support
the notion that low-grade viral ganglionitis contributes to pain. If chronic pain
reflects active infection, then antiviral therapy may help patients with PHN.
OBJECTIVE: To determine whether antiviral treatment helps reduce PHN-associated
pain. DESIGN: Prospective, open-label phase I/II clinical trial. SETTING:
Tertiary care university hospital. PATIENTS: Fifteen patients with moderate to
severe PHN. INTERVENTIONS: Intravenous acyclovir at a dosage of 10 mg/kg every 8 
hours for 14 days followed by oral valacyclovir at a dosage of 1000 mg 3 times
per day for 1 month. MAIN OUTCOME MEASURE: Numeric Rating Scale for Pain score.
RESULTS: As defined by a decrease of 2 or more points on the Numeric Rating Scale
for Pain, 8 (53%) of 15 patients reported improvement. CONCLUSION: Clinical
improvement reported by most of our patients warrants further investigation in a 
larger, randomized, double-blind, placebo-controlled trial.

Publication Types: 
    Clinical Trial, Phase I
    Clinical Trial, Phase II
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16682531 [PubMed - indexed for MEDLINE]

476: J Neurol. 2006 Aug;253(8):1103-10. Epub 2006 May 6.

Comment in:
    J Neurol. 2006 Aug;253(8):1102.

Acute urinary retention due to benign inflammatory nervous diseases.

Sakakibara R, Yamanishi T, Uchiyama T, Hattori T.

Department of Neurology, Chiba University, 1-8-1 Inohana Chuo-ku, 260-8670 Chiba,
Japan. sakakibara@faculty.chiba-u.jp

Both neurologists and urologists might encounter patients with acute urinary
retention due to benign inflammatory nervous diseases. Based on the mechanism of 
urinary retention, these disorders can be divided into two subgroups: disorders
of the peripheral nervous system (e.g., sacral herpes) or the central nervous
system (e.g., meningitis-retention syndrome [MRS]). Laboratory abnormalities
include increased herpes virus titers in sacral herpes, and increased myelin
basic protein in the cerebrospinal fluid (CSF) in some cases with MRS. Urodynamic
abnormality in both conditions is detrusor areflexia; the putative mechanism of
it is direct involvement of the pelvic nerves in sacral herpes; and acute spinal 
shock in MRS. There are few cases with CSF abnormality alone. Although these
cases have a benign course, management of the acute urinary retention is
necessary to avoid bladder injury due to overdistension. Clinical features of
sacral herpes or MRS differ markedly from those of the original "Elsberg
syndrome" cases.

PMID: 16680560 [PubMed - indexed for MEDLINE]

477: J Postgrad Med. 2006 Apr-Jun;52(2):153-4.

Cicatricial ectropion due to herpes zoster ophthalmicus.

Sanghvi CA, Leatherbarrow B, Ataullah S.

Department of Ophthalmology, Royal Eye Hospital, Oxford Road, Manchester M13 9WH,
United Kingdom. casanghvi@yahoo.co.uk.

Publication Types: 
    Letter

PMID: 16679689 [PubMed - in process]

478: Postgrad Med J. 2006 May;82(967):351-2.

Chickenpox, chickenpox vaccination, and shingles.

Welsby PD.

Infectious Diseases Unit, Western General Hospital, Edinburgh EH4 2XU, UK.
P.Welsby@ed.ac.uk

Chickenpox in the United Kingdom, where vaccination is not undertaken, has had a 
stable epidemiology for decades and is a routine childhood illness. Because of
vaccination, chickenpox is now a rarity in the USA. In the UK vaccination is not 
done because introduction of a routine childhood vaccination might drive up the
age at which those who are non-immune get the illness (chickenpox tends to be
more severe the older you are), and the incidence of shingles may increase. The
United Kingdom is waiting to see what happens in countries where vaccination is
routine.

Publication Types: 
    Review

PMID: 16679476 [PubMed - indexed for MEDLINE]

479: Postgrad Med J. 2006 May;82(967):e6.

A 2 year old with a rash.

Martin K, Elias-Jones A.

Department of Neonatology, Leicester General Hospital, Leicester LE5 4PW, UK.

Publication Types: 
    Case Reports
    Review

PMID: 16679462 [PubMed - indexed for MEDLINE]

480: Dermatol Clin. 2006 Apr;24(2):271-80, viii.

Dermatologic problems of older women.

Roberts WE.

Loma Linda University Medical School, Loma Linda, and Desert Dermatology Medical 
Associates, 39-700 Bob Hope Drive, Suite 115, Rancho Mirage, CA 92270, USA.
drwerderm@aol.com

Women are living longer today, composing the majority of persons aged 65 and
over. Their dermatologic needs are unique and cross ethnic and cultural lines.
With this increased life expectancy comes an increased occurrence of skin
disorders. The identification and treatment of these conditions is important for 
the practicing clinician. This article reviews some of the more common
dermatologic disorders of older women, and discusses the latest treatments and
issues facing this geriatric population.

Publication Types: 
    Review

PMID: 16677973 [PubMed - indexed for MEDLINE]

481: Mayo Clin Womens Healthsource. 2006 Jun;10(6):6.

Shingles. The return of the chickenpox virus.

[No authors listed]

PMID: 16675921 [PubMed - indexed for MEDLINE]

482: Encephale. 2005 Oct;31 Pt 2:S71-2.

[Atypical hypersomnia]

[Article in French]

Marchand F, Pelatan C, Legout A.

Service Hospitalo-Universitaire, Hopital Sainte-Anne, 1, rue Cabanis, 75014
Paris.

Publication Types: 
    Case Reports

PMID: 16673716 [PubMed - indexed for MEDLINE]

483: Clin Infect Dis. 2006 Jun 1;42(11):1639-46. Epub 2006 Apr 28.

Comment in:
    Clin Infect Dis. 2007 Jan 1;44(1):147-8; author reply 148-9.

Immune reconstitution syndrome in HIV: validating a case definition and
identifying clinical predictors in persons initiating antiretroviral therapy.

Robertson J, Meier M, Wall J, Ying J, Fichtenbaum CJ.

Department of Internal Medicine, Division of Infectious Diseases, University of
Cincinnati College of Medicine, Cincinnati, Ohio 45267-0560, USA.
roberj5@ucmail.uc.edu

BACKGROUND: Clinical deterioration after initiation of antiretroviral therapy may
result from restored immunity. There is no standard clinical definition for
immune reconstitution syndrome. The objectives of this study were to validate a
proposed definition and to identify factors predictive of immune reconstitution
syndrome. METHODS: This was a retrospective case-control study from an academic
university medical practice. Cases were matched to > or =2 control subjects by
CD4+ cell count at the time of initiation of antiretroviral therapy. Cases and
"mock cases" were blindly reviewed by 2 human immunodeficiency virus (HIV)
experts. RESULTS: Twenty possible cases of immune reconstitution syndrome were
identified; HIV experts excluded all cases of herpes zoster (shingles), with
agreement on real and mock cases of 92%. For 14 confirmed case patients (compared
with 40 control subjects), immune reconstitution syndrome was associated with a
higher number of prior opportunistic infections (P=.003) and higher CD8+ cell
counts at baseline (P=.05) and at week 12 (P=.02). Immune reconstitution syndrome
was associated with lower baseline levels of alanine aminotransferase (P=.05) and
hemoglobin (P=.02). On multivariate analysis, the number of prior opportunistic
infections (odds ratio, 2.7; P=.007) and lower hemoglobin level at baseline (odds
ratio, 0.8; P=.003) were independently associated with development of immune
reconstitution syndrome. A predictive model was defined by classification and
regression tree analysis with a sensitivity and specificity of 78.57% and 87.50%,
respectively, for an importance score of > or =4 (on a scale of 0.0 to 100.0),
and 92.86% and 80.00%, respectively, for a score of > or =2, using the number of 
prior opportunistic infections, CD8+ cell count, and hemoglobin level.
CONCLUSIONS: A standard definition for immune reconstitution syndrome is
possible. Patients with a greater severity of illness at initiation of
antiretroviral therapy are at risk for immune reconstitution syndrome. The model 
defined by classification and regression tree analysis may provide a basis for
risk stratification before initiation of antiretroviral therapy.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16652323 [PubMed - indexed for MEDLINE]

484: Indian Pediatr. 2006 Apr;43(4):353-6.

Herpes zoster with dissemination.

Singal A, Mehta S, Pandhi D.

Department of Dermatology and STD, University College of Medical Sciences and GTB
Hospital, Delhi 110 095, India.

Herpes zoster or shingles is an acute vesico-bullous cutaneous infection
characterized by dermatomal distribution, predominantly in adults. Extensive
cutaneous dissemination has been reported in immunocompromised patients. However,
its existence is documented in immunocompetent individuals as well. We report two
children with disseminated herpes zoster, one of whom was immunocompromised
secondary to severe mal-nutrition and had associated orbital septal cellulitis.

Publication Types: 
    Case Reports

PMID: 16651676 [PubMed - indexed for MEDLINE]

485: J Eur Acad Dermatol Venereol. 2006 Apr;20(4):470-2.

Cutaneous multifocal melanoma metastases clinically resembling herpes zoster.

Kondras K, Zalewska A, Janowski P, Kordek R.

Publication Types: 
    Case Reports
    Letter

PMID: 16643157 [PubMed - indexed for MEDLINE]

486: J Biol Chem. 2006 Jun 30;281(26):18193-200. Epub 2006 Apr 24.

Crystal structure of the herpes simplex virus 1 DNA polymerase.

Liu S, Knafels JD, Chang JS, Waszak GA, Baldwin ET, Deibel MR Jr, Thomsen DR,
Homa FL, Wells PA, Tory MC, Poorman RA, Gao H, Qiu X, Seddon AP.

Exploratory Medicinal Sciences, Pfizer Inc., Eastern Point Road, Groton, CT
06340, USA. shenping.liu@pfizer.com

Herpesviruses are the second leading cause of human viral diseases. Herpes
Simplex Virus types 1 and 2 and Varicella-zoster virus produce neurotropic
infections such as cutaneous and genital herpes, chickenpox, and shingles.
Infections of a lymphotropic nature are caused by cytomegalovirus, HSV-6, HSV-7, 
and Epstein-Barr virus producing lymphoma, carcinoma, and congenital
abnormalities. Yet another series of serious health problems are posed by
infections in immunocompromised individuals. Common therapies for herpes viral
infections employ nucleoside analogs, such as Acyclovir, and target the viral DNA
polymerase, essential for viral DNA replication. Although clinically useful, this
class of drugs exhibits a narrow antiviral spectrum, and resistance to these
agents is an emerging problem for disease management. A better understanding of
herpes virus replication will help the development of new safe and effective
broad spectrum anti-herpetic drugs that fill an unmet need. Here, we present the 
first crystal structure of a herpesvirus polymerase, the Herpes Simplex Virus
type 1 DNA polymerase, at 2.7 A resolution. The structural similarity of this
polymerase to other alpha polymerases has allowed us to construct high confidence
models of a replication complex of the polymerase and of Acyclovir as a DNA chain
terminator. We propose a novel inhibition mechanism in which a representative of 
a series of non-nucleosidic viral polymerase inhibitors, the
4-oxo-dihydroquinolines, binds at the polymerase active site interacting
non-covalently with both the polymerase and the DNA duplex.

PMID: 16638752 [PubMed - indexed for MEDLINE]

487: J Gastroenterol Hepatol. 2006 Mar;21(3):620.

Gastrointestinal: Zosteriform metastases to the skin.

Kamisawa T, Takahashi M, Nakajima H, Egawa N.

Publication Types: 
    Case Reports

PMID: 16638112 [PubMed - indexed for MEDLINE]

488: Georgian Med News. 2006 Mar;(132):60-4.

Hiv prevalence among high risk behavior group persons with herpes zoster
infection.

Sharvadze L, Tsertsvadze T, Gochitashvili N, Stvilia K, Dolmazashvili E.

Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi,
Georgia.

The aim of the two year (2003-2005) study was to study the HIV prevalence among
high risk behavior groups of persons with Herpes Zoster infection. For this
purpose we have investigated the high risk group patients: 1257 prisoners (1st
group), 1543 IDUs (2nd group) and 1350 persons including: homosexuals, persons
with history of frequent unprotected sex and persons with hepatitis B and C (3rd 
group). We revealed the persons with current or previous history of Herpes
Zoster, and studied HIV prevalence among them. Besides, we have studied the
immune status of revealed HIV positive persons, relationship between disease
(Herpes Zoster) severity and CD4 count. Herpes Zoster infection was diagnosed
based on clinical symptoms, anamnesis and by detection of VZV specific IgM and
IgG by ELISA. HIV infection was diagnosed by ELISA method and was confirmed by
Western Blot. CD4 count was detected by immunophenotyping technique and was
analyzed using a FACSCalibur flow cytometer. The total prevalence of HIV
infection among high risk behavior group persons with Herpes Zoster infection was
18,9% (31 HIV cases out of 164). The disease (Herpes Zoster) severity and
duration was associated with decreased rate of cellular immunity, CD4 count.
Herpes Zoster has a positive predictive value for HIV infection, predominantly
recurrent Herpes Zoster. Herpes Zoster should be recognized as a marker condition
indicating the necessity of screening for HIV, especially in Georgia, the region 
where the problem of IDU exists.

PMID: 16636383 [PubMed - indexed for MEDLINE]

489: Am J Kidney Dis. 2006 May;47(5):915-22.

Fatal relapse of ANCA-associated glomerulonephritis triggered by successive
Epstein-Barr and varicella zoster virus infections.

Schned AR, Ornvold K, Tsongalis GJ, Chobanian MC.

Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756,
USA. alan.schned@dartmouth.edu

Publication Types: 
    Case Reports

PMID: 16632033 [PubMed - indexed for MEDLINE]

490: Rinsho Ketsueki. 2006 Mar;47(3):210-3.

[Acyclovir combined with plasma exchange for disseminated varicella-zoster virus 
infection after bone marrow transplantation]

[Article in Japanese]

Lee C, Koike M, Oshimi K, Terakura S, Kodera Y.

Department of Hematology, Juntendo University, Shizuoka Hospital.

In 2001, a 45-year-old man with severe aplastic anemia received a bone marrow
transplantation from his HLA-identical sister, 2.5 years after which he developed
severe liver dysfunction together with abdominal pain, disturbance of
consciousness and generalized vesicles. Disseminated varicella-zoster virus
infection was diagnosed by the detection of VZV DNA. Acyclovir and plasma
exchange rapidly controlled his VZV-related symptoms and signs. Disseminated VZV 
infection is often fatal, but acyclovir and plasma exchange may be useful for
such infection by reducing the circulating viral load.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16629486 [PubMed - indexed for MEDLINE]

491: Am J Dermatopathol. 2006 Apr;28(2):181-6.

Comment in:
    Am J Dermatopathol. 2007 Feb;29(1):109-11.

Herpes incognito most commonly is herpes zoster and its histopathologic pattern
is distinctive!

Boer A, Herder N, Blodorn-Schlicht N, Falk T.

Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany.
boer@dermatologikum.de

Infections of the skin by herpesviruses do not always present themselves in
typical fashion. Conventional microscopy is used routinely to confirm infection
by herpesviruses, but sometimes typical signs such as multinucleated epithelial
cells or "ghosts" of them are not encountered in a specimen (so-called herpes
incognito). We studied 35 patients in whom infection with herpesviruses was
differentially diagnosed clinically but in whom a biopsy specimen had been taken 
for confirmation. Only those patients in whom histopathologic findings had been
interpreted as being "not diagnostic" of herpesvirus infection by 2 independent
dermatopathologists were included. Clinical and histopathologic findings were
correlated with results from polymerase chain reaction studies on formalin-fixed 
paraffin-embedded tissue. Polymerase chain reaction revealed herpesvirus-specific
DNA in 12 of 35 specimens, 10 being varicella zoster virus (VZV) positive, 1
herpes simplex virus (HSV)-2 positive, and 1 HSV-1 positive. Ten of these 12
cases presented themselves in very similar fashion (8 VZV, 1 HSV-1, 1 HSV-2). All
lesions were macular or papular and typified mostly by dense perivascular and
sparse interstitial superficial and deep infiltrates of lymphocytes, sometimes
assuming a patchy lichenoid pattern. Infiltrates were prominent in and around
adnexal structures, often peppering follicles, sebaceous glands, and eccrine
glands. Lymphocytes were also found in the lower part of the epidermis
accompanied by a combination of spongiosis and vacuolar alteration. The papillary
dermis was often edematous; extravasated erythrocytes in variable numbers were a 
common finding. Lymphocytes sometimes had large and polygonal nuclei. Neutrophils
and nuclear dust were present occasionally; eosinophils were rare. We conclude
that herpes incognito most commonly is herpes zoster and its histopathologic
pattern is distinctive.

PMID: 16625086 [PubMed]

492: Suppl Clin Neurophysiol. 2006;58:153-70.

Neuropathic facial pain.

Haanpaa M, Truini A.

Pain Clinic, Department of Neurosurgery, Helsinki University Hospital, 00029 HUS,
Helsinki, Finland. maija.haanpaa@hus.fi

Publication Types: 
    Review

PMID: 16623329 [PubMed - indexed for MEDLINE]

493: Clin Otolaryngol. 2006 Apr;31(2):144-8.

Prognostic value of electroneurography in Bell's palsy and Ramsay-Hunt's
syndrome.

Lee DH, Chae SY, Park YS, Yeo SW.

Department of Otolaryngology - Head and Neck Surgery, College of Medicine, The
Catholic University of Korea, Seoul, South Korea. leedh0814@catholic.ac.kr

OBJECTIVES: This study evaluated the accuracy of electroneurography to predict
the prognosis of Bell's palsy and Ramsay-Hunt's syndrome. DESIGN: A
retrospective, institutional review board-approved study. SETTING: A secondary
referral and a university-based centre. PARTICIPANTS: The patients had been
treated for a sudden onset unilateral facial paralysis over the past 10 years
(1994-2004). This retrospective study included only those patients who had been
followed up for at least 3 months or if they had reached a complete recovery
before then. MAIN OUTCOMES MEASURES: House-Backmann grade versus
electroneurography value. RESULTS: The recovery rates to House-Brackmann grade II
or better were 95% in those with Bell's palsy and 84% in those with herpes zoster
oticus. The electroneurography value of the recovery and non-recovery groups from
those with either Bell's palsy or herpes zoster oticus was similar. The logistic 
regression model between the electroneurography values and the probability of
recovery showed no correlation in those with Bell's palsy or with herpes zoster
oticus. This study did not identify the proper electroneurography value that had 
enough appropriate sensitivity and specificity to predict the prognosis of
paralysis accurately in Bell's palsy or in herpes zoster oticus patients.
CONCLUSION: Electroneurography performed between day 7 and 10 for Bell's palsy or
day 10 and 14 for herpes zoster oticus does not provide accurate information on
the prognosis or recovery rate of the facial paralysis.

PMID: 16620335 [PubMed - indexed for MEDLINE]

494: J Dermatol. 2006 Mar;33(3):233-5.

Postherpetic paresis of the lower limb.

Okamoto O, Kiyomoto Y, Okazaki T, Fujiwara S.

Publication Types: 
    Case Reports
    Letter

PMID: 16620237 [PubMed - indexed for MEDLINE]

495: J Clin Virol. 2006 Jun;36(2):111-8. Epub 2006 Apr 17.

European seroepidemiology network 2: Standardisation of assays for
seroepidemiology of varicella zoster virus.

de Ory F, Echevarria JM, Kafatos G, Anastassopoulou C, Andrews N, Backhouse J,
Berbers G, Bruckova B, Cohen DI, de Melker H, Davidkin I, Gabutti G, Hesketh LM, 
Johansen K, Jokinen S, Jones L, Linde A, Miller E, Mossong J, Nardone A, Rota MC,
Sauerbrei A, Schneider F, Smetana Z, Tischer A, Tsakris A, Vranckx R.

Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Majadahonda,
Madrid, Spain. fory@isciii.es

BACKGROUND: The aim of the European Sero-Epidemiology Network (ESEN2) is to
harmonise the serological surveillance of vaccine-preventable diseases in Europe.
OBJECTIVE: To allow comparison of antibody prevalence in different countries by
standardising results into common units. STUDY DESIGN: For varicella zoster virus
(VZV), a reference laboratory established a panel of 148 samples, characterised
by indirect enzyme-immunoassay (ELISA), indirect immunofluorescence, and
complement fixation test. Fifty-seven samples were also studied by the
fluorescence antibody to membrane antigen test. The geometric mean of the
antibody activity (GMAA) obtained from four ELISA determinations was used to
characterise each sample of the panel as positive (GMAA: >100 mIU/ml), equivocal 
(GMAA: 50-100 mIU/ml) or negative (GMAA: <50 mIU/ml) for antibody to VZV
(anti-VZV). Thirteen laboratories, using five different ELISA tests, tested the
panel. RESULTS: Agreement with the reference laboratory was above 85% in all
cases, and the R(2) values obtained from regression analysis of the quantitative 
results were always higher than 0.87. Finally, the regression equations could be 
used to convert national values into a common unitage. CONCLUSION: This study
confirmed that results for anti-VZV obtained by different ELISA methods can be
converted into common units, enabling the comparison of the seroprevalence
profiles obtained in the participant countries.

Publication Types: 
    Comparative Study
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 16616612 [PubMed - indexed for MEDLINE]

496: Nippon Rinsho. 2006 Mar;64 Suppl 3:321-5.

[Varicella vaccine]

[Article in Japanese]

Kamiya H.

National Hospital Organization Mie National Hospital.

Publication Types: 
    Review

PMID: 16615492 [PubMed - indexed for MEDLINE]

497: Nippon Rinsho. 2006 Mar;64 Suppl 3:311-5.

[Treatment of alpha herpesvirus infections in ophthalmology]

[Article in Japanese]

Shiota H, Nakahira T.

Department of Ophthalmology & Visual Neuroscience, Institute of Health
Biosciences, The University of Tokushima Graduate School.

Publication Types: 
    Review

PMID: 16615490 [PubMed - indexed for MEDLINE]

498: Nippon Rinsho. 2006 Mar;64 Suppl 3:306-10.

[Treatment of alpha-herpes virus infections]

[Article in Japanese]

Honda M.

Department of Dermatology, Aoto Hospital, Jikei University School of Medicine.

Publication Types: 
    Review

PMID: 16615489 [PubMed - indexed for MEDLINE]

499: Nippon Rinsho. 2006 Mar;64 Suppl 3:285-9.

[Postherpetic neuralgia]

[Article in Japanese]

Miyazaki T, Tanabe Y, Iseki M.

Department of Anesthesiology & Pain Medicine, Juntendo University, School of
Medicine.

Publication Types: 
    Review

PMID: 16615485 [PubMed - indexed for MEDLINE]

500: Nippon Rinsho. 2006 Mar;64 Suppl 3:281-4.

[Ramsay Hunt syndrome]

[Article in Japanese]

Furuta Y.

Department of Otolaryngology Head & Neck Surgery, Hokkaido University Graduate
School of Medicine.

Publication Types: 
    Review

PMID: 16615484 [PubMed - indexed for MEDLINE]

501: Nippon Rinsho. 2006 Mar;64 Suppl 3:272-5.

[Meningitis]

[Article in Japanese]

Nakajima H.

First Department of Internal Medicine, Osaka Medical College.

Publication Types: 
    Review

PMID: 16615482 [PubMed - indexed for MEDLINE]

502: Nippon Rinsho. 2006 Mar;64 Suppl 3:260-3.

[Herpes zoster]

[Article in Japanese]

Yoshida M.

First Department of Dermatology, School of Medicine, Toho University.

Publication Types: 
    Review

PMID: 16615479 [PubMed - indexed for MEDLINE]

503: Nippon Rinsho. 2006 Mar;64 Suppl 3:243-51.

[Acute retinal necrosis due to herpesviridae infections]

[Article in Japanese]

Usui N.

Department of Ophthalmology, Shinkawabashi Hospital.

Publication Types: 
    Review

PMID: 16615476 [PubMed - indexed for MEDLINE]

504: Nippon Rinsho. 2006 Mar;64 Suppl 3:239-42.

[Keratoconjunctivitis due to alphaherpesvirinae]

[Article in Japanese]

Shimomura Y.

Department of Ophthalmology, Kinki University School of Medicine.

Publication Types: 
    Review

PMID: 16615475 [PubMed - indexed for MEDLINE]

505: Nippon Rinsho. 2006 Mar;64 Suppl 3:234-8.

[Serodiagnosis for alphaherpesvirinae infections]

[Article in Japanese]

Saito Y.

Department of Infection and Immunology, SRL, Inc.

Publication Types: 
    Review

PMID: 16615474 [PubMed - indexed for MEDLINE]

506: Nippon Rinsho. 2006 Mar;64 Suppl 3:230-3.

[Diagnosis of VZV infection]

[Article in Japanese]

Ozaki T.

Department of Pediatrics, Showa Hospital.

Publication Types: 
    Review

PMID: 16615473 [PubMed - indexed for MEDLINE]

507: Nippon Rinsho. 2006 Mar;64 Suppl 3:221-5.

[Epidemiology of VZV infection]

[Article in Japanese]

Suga S.

Department of Pediatrics, Banbuntanehotokukai Hospital, Fujita Health University.

Publication Types: 
    Review

PMID: 16615471 [PubMed - indexed for MEDLINE]

508: Nippon Rinsho. 2006 Mar;64 Suppl 3:184-7.

[Immune responses to varicella-zoster virus infection]

[Article in Japanese]

Yasumoto S.

Department of Dermatology, Kurume University School of Medicine.

Publication Types: 
    Review

PMID: 16615464 [PubMed - indexed for MEDLINE]

509: Nippon Rinsho. 2006 Mar;64 Suppl 3:133-9.

[Varicella-zoster virus genome and the genes]

[Article in Japanese]

Okuno T.

Department of Microbiology, Hyogo College of Medicine.

Publication Types: 
    Review

PMID: 16615454 [PubMed - indexed for MEDLINE]

510: Nippon Rinsho. 2006 Mar;64 Suppl 3:95-8.

[Herpesvirus infections in dermatology]

[Article in Japanese]

Honda M.

Department of Dermatology, Aoto Hospital, Jikei University School of Medicine.

Publication Types: 
    Review

PMID: 16615448 [PubMed - indexed for MEDLINE]

511: Nippon Rinsho. 2006 Mar;64 Suppl 3:86-9.

[Herpesvirus infection in the field of ophthalmology]

[Article in Japanese]

Shimomura Y.

Department of Ophthalmology, Kinki University School of Medicine.

Publication Types: 
    Review

PMID: 16615446 [PubMed - indexed for MEDLINE]

512: Nippon Rinsho. 2006 Mar;64 Suppl 3:81-5.

[Herpes virus infection in obstetrics and gynecology]

[Article in Japanese]

Kawana T.

Department of Obstetrics and Gynecology, Teikyo University School of Medicine,
Mizonokuchi Hospital.

Publication Types: 
    Review

PMID: 16615445 [PubMed - indexed for MEDLINE]

513: Nippon Rinsho. 2006 Mar;64 Suppl 3:73-6.

[Herpesvirus infections in hematological diseases]

[Article in Japanese]

Karasuno T, Hiraoka A.

Hematology/Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases.

Publication Types: 
    Review

PMID: 16615443 [PubMed - indexed for MEDLINE]

514: Pediatr Blood Cancer. 2007 Jun 15;48(7):716.

Comment on:
    Pediatr Blood Cancer. 2005 Aug;45(2):191-4.

Disseminated Varicella-Zoster virus infection in a girl with T-lineage acute
lymphoblastic leukemia.

Akiyama M, Kobayashi N, Fujisawa K, Eto Y.

Publication Types: 
    Case Reports
    Comment
    Letter

PMID: 16607647 [PubMed - indexed for MEDLINE]

515: Am J Trop Med Hyg. 2006 Apr;74(4):591-2.

Varicella zoster virus meningitis complicating sodium stibogluconate treatment
for cutaneous leishmaniasis.

Hartzell JD, Aronson NE, Nagaraja S, Whitman T, Hawkes CA, Wortmann G.

Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC 
20307-5001, USA. Joshua.hartzell@na.amedd.army.mil

Sodium stibogluconate (Pentostam(R); GlaxoSmithKline) is a pentavalent antimonial
compound used in the treatment of leishmaniasis, which has an association with
reactivation of varicella zoster virus (VZV). We report the first known case of
an immunocompetent adult who developed VZV aseptic meningitis and dermatomal
herpes zoster during treatment with sodium stibogluconate.

Publication Types: 
    Case Reports

PMID: 16606989 [PubMed - indexed for MEDLINE]

516: Actas Dermosifiliogr. 2006 Mar;97(2):103-14.

[Update in the treatment of herpes zoster]

[Article in Spanish]

Espana A, Redondo P.

Departamento de Dermatologia, Clinica Universitaria de Navarra, Facultad de
Medicina, Spain.

The systemic treatment of herpes zoster shortens the healing process, and
prevents or alleviates pain and other acute or chronic complications, especially 
when it is administered in the first 72 hours after symptoms appear. This
treatment is especially indicated in patients over the age of 50 and in those
who, regardless of age, have head and neck involvement, especially in herpes
zoster ophthalmicus. The drugs approved in Europe for the systemic treatment of
herpes zoster are aciclovir, valaciclovir, famciclovir and brivudine. Brivudine
shows greater effectiveness against the varicella-zoster virus than aciclovir and
its derivatives, and can be given just once a day for seven days, compared to
multiple doses of the latter. As opposed to the others, brivudine is a
non-nephrotoxic drug that should not be administered to immunodepressed patients 
or to those being treated with 5-fluorouracil. The treatment of herpes zoster to 
reduce pain should be combined with analgesics and neuroactive agents
(amitriptyline, gabapentin, etc). While corticosteroids are of dubious efficacy
in the treatment of post-herpes neuralgia, the intensity and duration of the pain
can be reduced with some topical treatments (capsaicin, lidocaine patches, etc). 
Finally, this review discusses treatment guidelines for special locations
(cranial nerves) and different subpopulations (children, pregnant women,
immunodepressed patients, etc).

Publication Types: 
    English Abstract
    Review

PMID: 16595111 [PubMed - indexed for MEDLINE]

517: Acta Derm Venereol. 2006;86(1):73-4.

Postherpetic paresis mimicking an abdominal herniation.

Giuliani A, Galati G, Parisi L, Ricciardulli T, Bartolo M, Tartaglia E, Grimaldi 
M, Pranteda G.

Publication Types: 
    Case Reports
    Letter

PMID: 16586000 [PubMed - indexed for MEDLINE]

518: Ann Intern Med. 2006 Apr 4;144(7):535-7.

Evidence for vascular spread of varicella zoster-associated vasculopathy.

Saraya T, Shimura C, Wada H, Aoshima M, Goto H.

Publication Types: 
    Case Reports
    Letter

PMID: 16585673 [PubMed - indexed for MEDLINE]

519: Nursing. 2006 Apr;36(4):18-9.

Shutting down shingles.

Snow M.

CNA Edicational Services, Kaysville, Utah, USA.

PMID: 16582721 [PubMed - indexed for MEDLINE]

520: Ann Otol Rhinol Laryngol. 2006 Mar;115(3):233-8.

Varicella-zoster virus load and cochleovestibular symptoms in Ramsay Hunt
syndrome.

Ohtani F, Furuta Y, Aizawa H, Fukuda S.

Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate 
School of Medicine, Sapporo, Japan.

OBJECTIVES: The mechanism by which varicella-zoster virus (VZV) reactivation
causes cochleovestibular symptoms (CVSs) in patients with Ramsay Hunt syndrome
(RHS) remains to be elucidated. The present study analyzed the relationship
between VZV load and the onset of CVSs in RHS. METHODS: The subjects consisted of
56 patients with RHS; 29 exhibited CVSs and facial paralysis (FP; group 1), and
27 exhibited FP without CVSs (group 2). The VZV DNA copy number in the saliva was
measured with a quantitative polymerase chain reaction. Anti-VZV antibodies were 
assayed by an enzyme-linked immunosorbent assay with paired sera. RESULTS: There 
was no significant difference in maximum viral copy number between the two
groups. In group 1, CVSs occurred at various times between the early phase and
the regression phase of VZV reactivation. In some patients, CVSs occurred in the 
early phase of VZV reactivation, before the onset of zoster lesions and FP.
CONCLUSIONS: There are various different patterns in the development of eighth
cranial nerve dysfunction, which is caused by progression of neuritis or
labyrinthitis following VZV reactivation. Our data suggest that CVSs in RHS may
also be caused by reactivation of VZV in the spiral and/or vestibular ganglia.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16572614 [PubMed - indexed for MEDLINE]

521: Am J Ophthalmol. 2006 Apr;141(4):782; author reply 782.

Comment on:
    Am J Ophthalmol. 2005 Jun;139(6):1135-6.

Chronic recurrent varicella-zoster virus keratitis confirmed by polymerase chain 
reaction testing.

Mortemousque B.

Publication Types: 
    Comment
    Letter

PMID: 16564841 [PubMed - indexed for MEDLINE]

522: Reprod Toxicol. 2006 May;21(4):350-82. Epub 2006 Mar 27.

Laboratory assessment and diagnosis of congenital viral infections: Rubella,
cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), 
parvovirus B19 and human immunodeficiency virus (HIV).

Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z.

Central Virology Laboratory, Ministry of Health and Faculty of Life Sciences,
Bar-Ilan University, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
ellamen@sheba.health.gov.il

Viral infections during pregnancy may cause fetal or neonatal damage. Clinical
intervention, which is required for certain viral infections, relies on
laboratory tests performed during pregnancy and at the neonatal stage. This
review describes traditional and advanced laboratory approaches and testing
methods used for assessment of the six most significant viral infections during
pregnancy: rubella virus (RV), cytomegalovirus (CMV), varicella-zoster virus
(VZV), herpes simplex virus (HSV), parvovirus B19 and human immunodeficiency
virus (HIV). Interpretation of the laboratory tests results according to studies 
published in recent years is discussed.

Publication Types: 
    Review

PMID: 16564672 [PubMed - indexed for MEDLINE]

523: Vaccine. 2006 May 1;24(18):3946-52. Epub 2006 Feb 24.

The epidemiology of varicella and herpes zoster in The Netherlands: implications 
for varicella zoster virus vaccination.

de Melker H, Berbers G, Hahne S, Rumke H, van den Hof S, de Wit A, Boot H.

Centre for Infectious Disease Epidemiology, National Institute of Public Health
and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
h.de.melker@rivm.nl

We studied the epidemiology of varicella (chickenpox) and herpes zoster
(shingles) in The Netherlands to assess the desirability to implement routine
varicella zoster virus vaccination in The Netherlands. Data on seroprevalence of 
varicella zoster virus in the general population (1995-1996), consultations of
general practitioners for varicella (2000-2002) and herpes zoster (1998-2001) and
hospital admissions due to varicella (1994-2001) and herpes zoster (1994-2001) in
The Netherlands were analysed. The seropositivity increased sharply with age from
18.4% for both 0- and 1-year-olds, to 48.9%, 59.0%, 75.7% and 93.0% for 2-, 3-,
4- and 5-year-olds, respectively, and varied between 97.5% and 100% for older age
groups. The average annual incidence of GP-consultations amounted to 253.5 and
325.0 per 100,000 for varicella and herpes zoster, respectively. The incidence of
hospital admission due to varicella and herpes zoster was 1.3 (2.3 including side
diagnosis) and 2.7 (5.8) per 100,000, respectively. Whilst for varicella, the
incidence of GP-consultations and hospital admissions were highest in childhood, 
for herpes zoster, these were highest in elderly. Insight into epidemiology of
varicella zoster is needed for the assessment of the desirability of introduction
of routine varicella zoster vaccination.

PMID: 16564115 [PubMed - indexed for MEDLINE]

524: J Ark Med Soc. 2006 Mar;102(9):237.

Call to action: Adult immunization.

Hopkins R.

PMID: 16562758 [PubMed - indexed for MEDLINE]

525: Nippon Ganka Gakkai Zasshi. 2006 Mar;110(3):193-8.

[Case of herpes zoster ophthalmicus with abducent palsy: the cause and magnetic
resonance imaging findings]

[Article in Japanese]

Iwao K, Kobayashi H, Okinami S.

Department of Ophthalmology, Faculty of Medicine, Saga University, Japan.

PURPOSE: To report the cause and magnetic resonance imaging (MRI) findings in a
case of abducent palsy following herpes zoster ophthalmicus. CASE: A 76-year-old 
man presented with acute onset of pain, a vesicular cutaneous eruption and herpes
zoster ophthalmicus on the right side. He developed complete abducent palsy on
the right side two weeks after onset. MRI with gadolinium enhancement showed
Meckel's sinus, which contains the trigeminal ganglion, and the abducent nerve on
the right side. The patient was treated with intravenous acyclovir and
methylprednisolone. The abnormal enhancement shown on MRI vanished immediately
and the ophthalmoplegia resolved significantly. CONCLUSION: This is the first
reported case where an affected cranial nerve was detected next to the
inflammatory cavernous sinus in ophthalmoplegia following herpes zoster
ophthalmicus. These MRI findings showed that this ophthlamoplegia was induced by 
direct viral invasion or extension of inflammation to the ipsilateral cranial
nerve. Further studies need to be performed to clarify the role of specific
antiviral therapy or anti-inflammatory agents in treating this complication of
herpes zoster.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16562507 [PubMed - indexed for MEDLINE]

526: Diagn Cytopathol. 2006 Mar;34(3):232-4.

Cytologic findings in Demodex folliculitis: a case report and review of the
literature.

Dong H, Duncan LD.

Department of Pathology, University of Tennessee Medical Center, Knoxville,
Tennessee 37920, USA.

Infectious folliculitis of the head and neck has various etiologies, including
bacteria, viruses, fungi, and parasites. Accurate morphologic recognition of
microorganisms in biopsy and cytologic specimens is paramount in facilitating
appropriate therapy. We report a case of a 37-yr-old white male with Demodex
folliculitis, who presented with an extensive and painful erythematous pustular
skin lesion along the right face and scalp in a dermatome pattern clinically
suggestive of Varicella zoster. Examination of scraped smears obtained from one
of these pustules revealed numerous parasitic organisms having morphologic
features typical of Demodex. Herein, we describe the patient's clinical
presentation, discuss the cytologic findings of scrape smears, and briefly review
the literature. 2006 Wiley-Liss, Inc.

Publication Types: 
    Case Reports

PMID: 16548003 [PubMed - indexed for MEDLINE]

527: Br J Dermatol. 2006 Apr;154(4):743-6.

Herpes folliculitis: clinical, histopathological, and molecular pathologic
observations.

Boer A, Herder N, Winter K, Falk T.

Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany.
boer@dermatologikum.de

BACKGROUND: Herpes folliculitis is a rare manifestation of herpes virus infection
and it is often misdiagnosed. Diagnostic criteria are not well established, only 
24 patients being reported in the literature. Recently it has been suggested that
herpetic folliculitis is more common in infections with varicella zoster (VZV)
than in those with herpes simplex viruses (HSV-1 and -2). OBJECTIVES: To refine
diagnostic criteria for folliculitis caused by VZV, HSV-1 and HSV-2, and to study
whether follicular involvement enables morphological differentiation between VZV 
and HSV infections. PATIENTS AND METHODS: Twenty-one patients with herpetic
infection of follicular epithelium were assessed clinically and
histopathologically. Polymerase chain reaction (PCR) studies for specific DNA of 
herpes viruses were performed on paraffin-embedded biopsy specimens. RESULTS: In 
17 of our cases PCR was positive for VZV, four were positive for HSV-1, none for 
HSV-2. The clinical presentation of herpes folliculitis often lacked vesicles or 
pustules (14/21). Histopathological features were often devoid of ballooning
(12/21), multinucleated giant cells (12/21) and keratinocytes with steel grey
nuclei (15/21). The most consistent findings were lymphocytic folliculitis and
perifolliculitis (20/21) and necrotic keratinocytes in follicular epithelium
(12/21). In zoster, but not in varicella eruption or HSV infections, follicular
involvement was unaccompanied by marked changes in the epidermal surface.
CONCLUSIONS: In biopsy specimens taken from herpes virus infections, involvement 
of follicular units is more commonly encountered in VZV infections compared with 
HSV infections. Early in the course, herpes folliculitis presents as lymphocytic 
folliculitis devoid of epithelial changes considered to be diagnostic of herpes
virus infections. Exclusive involvement of follicles is rather typical of zoster.

PMID: 16536821 [PubMed - indexed for MEDLINE]

528: Transplantation. 2006 Mar 15;81(5):809-10.

Nonspecific immunoglobulin and granulocyte-macrophage colony-stimulating factor
use in complicated varicella zoster: the first case report in a renal transplant 
recipient.

Vales-Albertos LJ, Andrade-Sierra J, Gomez-Navarro B, Monteon-Ramos F,
Rodriguez-Perez M, Torres-Lozano C, Cueto-Manzano AM.

Publication Types: 
    Case Reports
    Letter

PMID: 16534489 [PubMed - indexed for MEDLINE]

529: Int J Dermatol. 2006 Mar;45(3):280-4.

Patterns of skin manifestations and their relationships with CD4 counts among
HIV/AIDS patients in Cameroon.

Josephine M, Issac E, George A, Ngole M, Albert SE.

Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences,
University of Yaounde, Cameroon.

BACKGROUND: Skin manifestations are common clinical features among
HIV/AIDS-positive patients. Their frequencies, patterns and associated factors
have been shown to vary from region to region. The present study is aimed at
documenting skin manifestations and their relationships with CD4 cell counts
among HIV/AIDS patients in Cameroon. METHODS: This study lasted for 16 months
(from September 2001 to December 2002). After informed consent, data on skin
disorders, HIV status, CD4 and viral load were obtained by physical examination
and laboratory methods. RESULTS: Of the 384 subjects studied, 236 (61.5%) were
females and 148 (38.5%) were males. Up to 264 (68.8%) patients presented with at 
least one type of skin problem. Generalized prurigo, oral candidiasis, herpes
zoster, and vaginal candidiasis were the most common skin problems. Mean CD4 cell
count (128 +/- 85 cells/mm(3)) and mean viral load (79,433 copies/mL) in patients
with herpes zoster were higher (P < 0.001). Patients with oral candidiasis and
vaginal candidiasis had significantly lower (109 +/- 127 cells/mm(3), P < 0.02)
and higher (131 +/- 85 cells/mm(3), P < 0.05) mean CD4 cell counts, respectively.
Prurigo was associated with higher mean viral load (31,623 +/- 20 copies/mL, P < 
0.04). Viral lesions were associated with high mean CD4 cell count (123 +/- 83
cells/mm(3), P < 0.001). Kaposi's sarcoma and parasitic lesions (crusted scabies)
were both, respectively, associated with lower mean CD4 cell counts [(78 +/- 66
cells/mm(3), P < 0.001) (6 +/- 0 cells/mm(3), P < 0.04)]. CONCLUSION: We
conclude, first that skin problems are common in HIV-infected individuals in
Cameroon and that patients with advanced stages of these problems have relatively
very low mean CD4 cell counts. Second, that mucocutaneous disorders like vaginal 
candidiasis and herpes zoster occur early in HIV infection while Kaposi's sarcoma
is common in advanced HIV infection.

PMID: 16533229 [PubMed - indexed for MEDLINE]

530: Pain Med. 2006 Jan-Feb;7(1):89-91.

Botulinum toxin A relieved neuropathic pain in a case of post-herpetic neuralgia.

Liu HT, Tsai SK, Kao MC, Hu JS.

Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.

Botulinum toxin type A (BTX-A) has been widely used in many clinical disorders
including migraine, cervical dystonia, etc. The use of BTX-A in neuropathic pain,
however, is uncommon, and the application of the anti-nociceptive effect of
botulinum toxin is emerging. Here we report a case of an 80-year-old man who
suffered from severe pain of post-herpetic neuralgia which was refractory to the 
usual therapies. However, this neuropathic pain was dramatically relieved by
multiple BTX-A injection and the pain relief lasted 52 days.

Publication Types: 
    Case Reports

PMID: 16533208 [PubMed - indexed for MEDLINE]

531: Exp Eye Res. 2006 Jul;83(1):69-75. Epub 2006 Mar 10.

Characterization of the varicella zoster virus (VZV)-specific intra-ocular T-cell
response in patients with VZV-induced uveitis.

Milikan JC, Kuijpers RW, Baarsma GS, Osterhaus AD, Verjans GM.

Institute of Virology, Erasmus Medical Center, PO Box 1738, 3000 DR, Rotterdam,
The Netherlands.

Varicella zoster virus (VZV) is a well-known cause of infectious uveitis. The aim
of this study was to characterize the VZV-specific T-cell response in eyes of
patients with VZV-induced uveitis. T-cell lines (TCL) were generated by mitogenic
stimulation of intra-ocular fluid (IOF) samples obtained from eight patients with
VZV-induced uveitis. Two patients with herpes simplex virus (HSV)-induced uveitis
were included as disease controls. Characterization of individual T-cells in the 
TCL was performed by stimulating the TCL with mock, HSV-1 and VZV antigen pulsed 
autologous B cells and subsequent flow cytometric analyses. Virus specificity and
phenotype of the T-cells were identified by simultaneous detection of
intracellular gamma interferon and cell surface markers CD4, CD8, CD3 or T-cell
receptor (TCR) beta chain variable region (TCRBV) usage. The TCL obtained from
patients with HSV-1-induced uveitis contained higher numbers of T-cells reactive 
to HSV-1 compared to VZV. VZV-specific T-cells were detected in all TCL of the
patients diagnosed with VZV-induced uveitis. Four out of six TCL obtained from
patients with VZV-induced uveitis that were assayed for both viruses, contained
higher numbers of T-cells reactive to VZV compared to HSV-1. Detailed analyses of
the TCL of two patients demonstrated that the VZV reactivity within the assayed
TCL was dominated by T-cells expressing one specific TCRBV gene. The data
implicate that VZV-reactive T-cells infiltrate and participate in the local
inflammatory response in eyes of patients with VZV-induced uveitis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16530754 [PubMed - indexed for MEDLINE]

532: Am Fam Physician. 2006 Mar 1;73(5):882-4.

Treatment of herpes zoster.

Holten KB.

Clinton Memorial Hospital, University of Cincinnati Family Medicine Residency,
Wilmington, Ohio, USA. keholtenmd@cmhregional.com

PMID: 16529096 [PubMed - indexed for MEDLINE]

533: Rev Stomatol Chir Maxillofac. 2006 Feb;107(1):57-8.

[Unusual presentation of a common disease]

[Article in French]

Loeb I, Shahla M.

Service de Stomatologie et Chirurgie Maxillo-faciale, CHU Saint-Pierre,
Bruxelles, Belgique. isabelleloeb@yahoo.fr

Publication Types: 
    Case Reports

PMID: 16523180 [PubMed - indexed for MEDLINE]

534: Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jan;18(1):103-4. Epub 2006 Mar 
7.

Herpes zoster-associated acute urinary retention: a case report.

Julia JJ, Cholhan HJ.

Women's Continence Center of Greater Rochester, Rochester, NY, USA.
jjjulia73@hotmail.com

An 87-year-old woman presents with a 4-week history of urinary incontinence
during which she had been treated for disseminated herpes zoster virus (HZV). On 
physical exam painful vesicles involving the entire vulvar region with mainly
right sacral distribution were found. A catheterized volume exceeded 600 ml of
retained urine after the patient failed to void spontaneously. Multichannel
voiding-pressure urodynamic studies revealed an acontractile neurogenic bladder
with overflow incontinence. The patient was discharged on a conservative regimen 
with arrangement for visiting nurse services to perform intermittent
self-catheterization twice daily. Urodynamic testing was repeated 10 weeks after 
initial symptoms. During voiding cystometry a biphasic increase in detrusor
pressure of 15 cm H2O was observed with no increase in abdominal pressure. The
patient emptied 400 ml with a postvoid residual of 300 ml. Recovery from
HZV-associated bladder emptying dysfunction can be achieved usually through
conservative management, including intermittent self-catheterization. Complete
recovery time ranges from 4 to 10 weeks.

Publication Types: 
    Case Reports

PMID: 16520890 [PubMed - indexed for MEDLINE]

535: Kansenshogaku Zasshi. 2006 Jan;80(1):46-50.

[Varicella-zoster virus symptoms and polyneuropathy in a patient with human
immunodeficiency virus infection not improved until highly active anti-retroviral
therapy added to acyclovir therapy]

[Article in Japanese]

Takeoka H, Chong Y, Murata M, Furusyo N, Nabeshima S, Yamaji K, Kishihara Y,
Hayashi J.

Department of Environmental Medicine and Infectoius Desease, Faculity of Medical 
Sciences, Kyushu University.

In March 2003, a 34-year-old man with left facial palsy, dysphagia, and
hoarseness treated with acyclovir suffered worsened dermatological and
neurological problems. A routine blood test in early April showed the patient to 
be HIV-antibody positive, so he was transferred to our hospital. Blood analysis
showed serum HIV-RNA at 96,000 copies/mL and a CD 4 count of 170/microL. Brain
MRI taken on admission showed a T 2 high lesion in their left medulla. Acyclovir 
was thought to be ineffective due to reduced cell-mediated immunity because of
the HIV infection, and HAART therapy was begun. After two months of HAART, skin
lesions and the T 2 high lesion in left medulla improred. HIV-RNA became
undetectable and the CD 4 count exceeded 500/microL. Intracellular cytokine
analysis by flow cytometry showed a shift from Th 2 to Th 1 dominance. The
elimination of VZV may thus have been promoted by the combination of acyclovir
and HAART.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16519124 [PubMed - indexed for MEDLINE]

536: J Neuroophthalmol. 2006 Mar;26(1):47-8.

Magnetic resonance imaging of third cranial nerve palsy and trigeminal sensory
loss caused by herpes zoster.

Quisling SV, Shah VA, Lee HK, Policeni B, Smoker WR, Martin C, Lee AG.

Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City,
Iowa, USA.

A 44-year-old man with right-sided herpes zoster ophthalmicus (HZO) developed
ipsilateral third and sixth cranial nerve palsies and first-division trigeminal
(fifth cranial nerve) sensory loss. MRI revealed contrast enhancement of the
cisternal and cavernous portions of the third cranial nerve and high signal on a 
FLAIR sequence within the ipsilateral medulla at the presumed location of the
trigeminal nucleus and tract. To our knowledge, this is the first report of the
combination of these imaging findings in HZO.

Publication Types: 
    Case Reports

PMID: 16518167 [PubMed - indexed for MEDLINE]

537: J Pediatr Surg. 2006 Mar;41(3):e29-31.

Acquired intestinal aganglionosis after a lytic infection with varicella-zoster
virus.

Holland-Cunz S, Goppl M, Rauch U, Bar C, Klotz M, Schafer KH.

Department of Pediatric Surgery, University of Heidelberg, 69120 Heidelberg,
Germany. stefan_holland-cunz@med.uni-heidelberg.de

BACKGROUND AND PURPOSE: In this report, we present the first case of an
immunologically impaired child surviving a lytic varicella-zoster virus infection
affecting the enteric nervous system. In histological findings, myenteric and
submucous enteric ganglia were nearly completely absent owing to virus infection.
METHODS: A 3-year-old girl with acute lymphoblastic leukemia and generalized
varicella-zoster infection developed an ileus. She underwent multiple
laparotomies in which histological sections of the entire small intestine could
be obtained. RESULTS: The histological evaluation of these samples showed a
generalized aganglionosis with inflammatory residuals. A more detailed
immunohistochemical analysis using neuronal (PGP, enolase), glial (S100), and
lymphocytic (LCA) antibodies demonstrated a nearly complete neuronal loss.
CONCLUSION: To our knowledge, this is the first case of a secondary intestinal
aganglionosis after varicella-zoster virus infection.

Publication Types: 
    Case Reports

PMID: 16516611 [PubMed - indexed for MEDLINE]

538: Ann Epidemiol. 2006 Sep;16(9):692-5. Epub 2006 Mar 3.

Gender as an independent risk factor for herpes zoster: a population-based
prospective study.

Opstelten W, Van Essen GA, Schellevis F, Verheij TJ, Moons KG.

University Medical Center Utrecht, The Netherlands. w.opstelten@umcutrecht.nl

PURPOSE: Several studies reported a difference in herpes zoster (HZ) incidence
between males and females, but limitations in design and analysis impeded the
assessment of gender as an independent risk factor for HZ. This study examines
the independent etiologic association between gender and HZ. METHODS: A total of 
335,714 persons were observed prospectively during 2001. We registered gender and
HZ occurrence, as well as other risk factors for HZ. We calculated overall crude 
and adjusted odds ratios (ORs) and stratified to age. RESULTS: The HZ incidence
in females was 3.9/1000 patients/year (95% confidence interval [CI], 3.6-4.2),
and in males, 2.5/1000 patients/year (95% CI, 2.3-2.8), with a crude OR of 1.53
(95% CI, 1.36-1.74). After adjustment for potential confounders, the adjusted OR 
was 1.38 (95% CI, 1.22-1.56). The incidence was greater in females in the
middle-aged (age, 25 to 64 years; OR range, 1.36 to 1.83) and youngest group (OR,
1.31; 95% CI, 0.90-1.89). Gender effect was inverse in young adults (age, 15 to
24 years; OR, 0.64; 95% CI, 0.41-1.03). CONCLUSION: Female gender is an
independent risk factor for HZ in the 25- to 64-year-old age groups.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16516488 [PubMed - indexed for MEDLINE]

539: Hautarzt. 2006 Mar;57(3):207-12, 214-6.

[Infections with herpes simplex and varicella-zoster viruses during pregnancy]

[Article in German]

Marculescu R, Richter L, Rappersberger K.

Abteilung fur Dermatologie, Krankenanstalt Rudolfstiftung, Wien.

Primary infections with herpes simplex virus (HSV) and varicella-zoster virus
(VZV) may lead to severe illness in pregnancy. Both diseases may be associated
with transplacental virus transmission and fetal infection. Such infections can
lead to intrauterine death, severe malformations and premature birth; the
fetal/congenital varicella syndrome is well-defined. Herpes genitalis and
varicella at the time of labor may lead to life threatening neonatal-herpes or
varicella of the newborn. Currently neither active immunization nor neutralizing 
immunoglobulin is available for HSV infections. VZV-seronegative women in
child-bearing age can be vaccinated and pregnant women exposed to VZV can be
given specific immunoglobulins. While an infection is rarely blocked, the
severity is generally reduced. For severe disease antiviral treatment is
necessary, with valacyclovir and acyclovir represents the drugs of choice.
Primary or recurrent overt disease of the genital tract at the time of delivery
an indication for caesarean section. Suppression of recurrent genital herpes
during the last weeks of pregnancy with valacyclovir and acyclovir reduces the
need for surgical intervention. Neonates exposed to VZV should receive specific
immunoglobulin. If neonates show signs of either infection, immediate treatment
with acyclovir must be initiated.

Publication Types: 
    English Abstract
    Review

PMID: 16514526 [PubMed - indexed for MEDLINE]

540: J Eur Acad Dermatol Venereol. 2006 Mar;20(3):314-7.

Granuloma annulare on herpes zoster scars in a Hodgkin's disease patient
following autologous peripheral stem cell transplantation.

Sanli HE, Kocyigit P, Arica E, Kurtyuksel M, Heper AO, Ozcan M.

Department of Dermatology, Ankara University School of Medicine, Ankara, Turkey.

Various cutaneous lesions including granulomatous reactions may occur at sites of
resolved herpes zoster infection. A 46-year-old man with Hodgkin's disease
developed localized granuloma annulare lesions on herpes zoster scars 3 months
after allogeneic peripheral stem cell transplantation. This is the first case of 
granuloma annulare localized on herpes zoster scars that developed following
peripheral stem cell transplantation.

Publication Types: 
    Case Reports

PMID: 16503895 [PubMed - indexed for MEDLINE]

541: Scand J Infect Dis. 2006;38(3):227-8.

Varicella-zoster virus infection under administration of ganciclovir after
allogeneic bone marrow transplantation.

Mori T, Shimizu T, Yamazaki R, Aisa Y, Nakazato T, Ikeda Y, Okamoto S.

Division of Hematology, Department of Medicine, Keio University School of
Medicine, Shinanomachi, Tokyo, Japan. tmori@sc.itc.keio.ac.jp

PMID: 16500790 [PubMed - indexed for MEDLINE]

542: Odontostomatol Trop. 2005 Dec;28(112):19-23.

Group II and III lesions in HIV positive Nigerians attending the General Hospital
Lagos, Nigeria.

Wright AA, Agbelusi GA.

Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos,
Nigeria.

OBJECTIVE: To document the prevalence of Group II and Ill oral lesions of HIV in 
adult seropositive Nigerians. STUDY DESIGN: A longitudinal study of 100 HIV
infected adult Nigerian patients attending the HIV Clinic of the General
Hospital, Lagos, Nigeria. STUDY PERIOD: January 2001 to October 2002. METHOD:
Oral lesions were diagnosed based on documented diagnostic criteria by GREENSPAN 
et al, for oral manifestation of HIV. WHO classification of oral lesions based on
the degree of association with HIV infection was also used. Oral lesions were
treated using established treatment protocols. RESULTS: Seventy patients had oral
lesions of HIV, of these fourteen (20%) patients had Group II and III oral
lesions of HIV infection: Five (7%) patients had recurrent aphthous ulcers (RAU),
4 (6%) had herpes zoster of the trigeminal nerve. Majority of patients presented 
with oral symptoms severe enough to require use of appropriate medication.
Recurrence of oral lesions occurred in all cases of RAU seen. CONCLUSION: Group
II and III lesions are less prevalent than group I lesions in HIV infected adult 
Nigerians. They may be the presenting oral lesions of HIV/AIDS. These oral
lesions of HIV are associated with a lot of pain, morbidity and may also
compromise aesthetics. By compromising adequate nutrition and practice of good
oral hygiene, they may lead to further deterioration of the health of the patient
and can accelerate the course of the disease. Early recognition and diagnosis of 
these lesions by the oral clinician and/or trained dental practitioner affords
the patient the opportunity of receiving prompt and appropriate medical treatment
as well as counseling.

PMID: 16491918 [PubMed - indexed for MEDLINE]

543: Korean J Ophthalmol. 2005 Dec;19(4):302-4.

A case of complete ophthalmoplegia in herpes zoster ophthalmicus.

Shin HM, Lew H, Yun YS.

Department of Ophthalmology, Pochun CHA University College of Medicine, Pundang
CHA Hospital, Sungnam, Korea.

PURPOSE: To report a case with complete ophthalmoplegia after herpes zoster
ophthalmicus. METHODS: A 70-year-old male patient visited a clinic because of
vesicular eruptions over the left side of his face with severe pain. Drooping and
severe swelling of the left eyelid were present, along with keratitis and
uveitis. While the lid swelling and uveitis were improving, external
ophthalmoplegia and exophthalmos were discovered. Intramuscular injections of
dexamethasone 5 mg were given for 10 days, followed by oral administration of
prednisolone at a dosage of 15 mg for two weeks and 10 mg for two weeks. RESULTS:
The patient was fully recovered from the complete ophthalmoplegia and
exophthalmos six months after the onset of the cutaneous lesion. CONCLUSIONS:
Complete ophthalmoplegia is a rare ophthalmic complication of herpes zoster
infection. Therefore, an evaluation of extraocular muscle and lid function should
be performed during the examination of herpes zoster patients in order to screen 
for ophthalmoplegia.

Publication Types: 
    Case Reports

PMID: 16491822 [PubMed - indexed for MEDLINE]

544: Arch Dermatol. 2006 Feb;142(2):250-1.

Postherpetic poliosis.

Wu JJ, Huang DB, Tyring SK.

Publication Types: 
    Case Reports
    Letter

PMID: 16490864 [PubMed - indexed for MEDLINE]

545: Am J Ophthalmol. 2006 Mar;141(3):584-5.

Correlation between clinical suspicion and polymerase chain reaction verification
of infectious vitritis.

Acharya N, Lietman T, Cevallos V, Whitcher JP, Saidel M, Stone D, Duncan J,
Margolis TP.

Proctor Foundation, Department of Ophthalmology, University of California-San
Francisco, 95 Kirkham Street, San Francisco, CA 94143, USA.
nisha@stanfordalumni.org

PURPOSE: To compare polymerase chain reaction (PCR) results to presumptive
clinical diagnosis in patients with vitritis. DESIGN: Retrospective review of PCR
laboratory records from vitreous samples. METHODS: Fifty consecutive laboratory
records of vitreous samples sent for PCR testing were reviewed. Three reviewers
with uveitis training ranked the clinical suspicion of a specific diagnosis using
a classification system (scale of 1 to 4) and were masked to the PCR results.
RESULTS: The degree of clinical suspicion of a particular diagnosis was
significantly associated with a positive PCR result (P = .048). Higher clinical
suspicion was significantly more associated with a positive PCR result compared
with cases with lower clinical suspicion (P = .01). CONCLUSIONS: If the clinical 
suspicion of a specific diagnosis is low, the PCR for any infectious etiology is 
unlikely to be positive.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16490520 [PubMed - indexed for MEDLINE]

546: Am J Clin Dermatol. 2006;7(1):13-29.

Viral infections affecting the skin in organ transplant recipients: epidemiology 
and current management strategies.

Tan HH, Goh CL.

National Skin Centre, Singapore.

Viral skin infections are common findings in organ transplant recipients. The
most important etiological agents are the group of human herpesviruses (HHV),
human papillomaviruses (HPV), and molluscum contagiosum virus. HHV that are
important in this group of patients are herpes simplex virus (HSV) types 1 and 2,
varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV),
HHV-6 and -7, and HHV-8, which causes Kaposi sarcoma (KS). HSV infections are
characterized by their ability to establish latency and then reactivate at a
later date. The most common manifestations of HSV infection in organ transplant
recipients are mucocutaneous lesions of the oropharynx or genital regions.
Treatment is usually with acyclovir, valaciclovir, or famciclovir. Acyclovir
resistance may arise although the majority of acyclovir-resistant strains have
been isolated from AIDS patients and not organ transplant recipients. In such
cases, alternatives such as foscarnet, cidofovir, or trifluridine may have to be 
considered. VZV causes chickenpox as well as herpes zoster. In organ transplant
recipients, recurrent herpes zoster can occur. Acute chickenpox in organ
transplant patients should be treated with intravenous acyclovir. CMV infection
occurs in 20-60% of all transplant recipients. Cutaneous manifestations, which
include nonspecific macular rashes, ulcers, purpuric eruptions, and
vesiculobullous lesions, are seen in 10-20% of patients with systemic infection
and signify a poor prognosis. The present gold standard for treatment is
ganciclovir, but newer drugs such as valganciclovir appear promising. EBV is
responsible for some cases of post-transplant lymphoproliferative disorder, which
represents the greatest risk of serious EBV disease in transplant recipients.
HHV-6 and HHV-7 are two relatively newly discovered viruses and, at present, the 
body of information concerning these two agents is still fairly limited. KS is
caused by HHV-8, which is the most recently discovered lymphotrophic HHV.
Iatrogenic KS is seen in solid-organ transplant recipients, with a prevalence of 
0.5-5% depending on the patient's country of origin. HPV is ubiquitous, and organ
transplant recipients may never totally clear HPV infections, which are the most 
frequently recurring infections in renal transplant recipients. HPV infection in 
transplant recipients is important because of its link to the development of
certain skin cancers, in particular, squamous cell carcinoma. Regular
surveillance, sun avoidance, and patient education are important aspects of the
management strategy.

Publication Types: 
    Review

PMID: 16489840 [PubMed - indexed for MEDLINE]

547: J Drugs Dermatol. 2006 Feb;5(2):182-5.

The incidence of recurrent herpes simplex and herpes zoster infection during
treatment with arsenic trioxide.

Nouri K, Ricotti CA Jr, Bouzari N, Chen H, Ahn E, Bach A.

Department of Dermatology and Cutaneous Surgery, University of Miami, Miller
School of Medicine, Miami, Florida, USA. knouri@med.miami.edu

We report the incidence of varicella zoster virus (VZV) and herpes simplex virus 
(HSV) infection in patients with multiple myeloma and colon cancer who were
treated with arsenic trioxide for their disease. In this report, we discuss the
effects of arsenic on immune system, and suggest arsenic compounds as a possible 
predisposing factor for viral reactivation in these patients.

Publication Types: 
    Case Reports

PMID: 16485889 [PubMed - indexed for MEDLINE]

548: Scand J Gastroenterol. 2006 Feb;41(2):242-4.

Visceral varicella zoster virus infection after stem cell transplantation: a
possible cause of severe abdominal pain.

Leena M, Ville V, Veli-Jukka A.

Department of Medicine, Division of Infectious Diseases, Helsinki University
Central Hospital, Finland. leena.mattila@hus.fi

Reactivation of varicella zoster virus (VZV) is a common event after stem cell
transplantation (SCT). When activated in the abdominal cavity, the infection may 
be life threatening. Visceral presentation with VZV infection is uncommon,
although probably an under-diagnosed event in post-SCT patients. The interval
from onset of abdominal pain to the development of skin eruptions may delay the
initiation of specific antiviral therapy and symptoms may be incorrectly
diagnosed as surgical disease or graft-versus-host disease. We describe the case 
of a 53-year-old man who had undergone stem cell autograft for multiple myeloma
and developed visceral VZV infection with hepatitis, melaena and subileus 7
months later.

Publication Types: 
    Case Reports

PMID: 16484131 [PubMed - indexed for MEDLINE]

549: J Med Virol. 2006 Apr;78(4):514-6.

Two cases of varicella zoster virus meningitis found in pediatric patients after 
bone marrow transplantation despite valaciclovir prophylaxis and without skin
lesions.

Leveque N, Galambrun C, Najioullah F, Bleyzac N, Pages MP, Bertrand Y.

Laboratoire de virologie, Hopital E. Herriot, Hospices civils de Lyon, Lyon,
France.

Two cases of varicella zoster virus (VZV) meningitis are described in an
18-year-old girl and an 18-year-old boy. They occurred, respectively, 9 days and 
9 months after allogeneic bone marrow transplantation. VZV nucleic acid was
detected in the cerebrospinal fluid during the 1st week of illness. This
recurrence occurred despite valaciclovir prophylaxis and without skin lesions.
The two patients received aciclovir intravenously and immunoglobulins infusion.
They responded to treatment and their clinical state improved rapidly. Copyright 
2006 Wiley-Liss, Inc.

Publication Types: 
    Case Reports

PMID: 16482541 [PubMed - indexed for MEDLINE]

550: Dtsch Med Wochenschr. 2006 Feb 24;131(8):384-6.

Comment in:
    Dtsch Med Wochenschr. 2006 Jun 2;131(22):1290; author reply 1290.

[Disseminated herpes zoster in diabetes mellitus]

[Article in German]

Graue N, Grabbe S, Dissemond J.

Universitatsklinikum Essen, Klinik und Poliklinik fur Dermatologie, Venerologie
und Allergologie, Hufelandstrasse 55, 45147 Essen.

HISTORY AND ADMISSION FINDINGS: A 71-year old man presented with painful
hemorrhagic vesicles and papules over the entire body that had persisted for
three days. Type 2 diabetes mellitus type 2 had been diagnosed 20 years ago and
had not been treated for the last 5 years. Therapy had been discontinued by the
patient. INVESTIGATIONS: HbA1c (11,9%) and blood glucose levels (up to 360 mg/dl)
were abnormal. Varicella-zoster-DNA was replicated by PCR from the vesicle fluid.
DIAGNOSIS AND TREATMENT: After the clinical diagnosis of disseminated herpes
zoster had been confirmed systemic therapy with aciclovir 10 mg/kg day was
started. There was no evidence of malignancy. Insulin therapy was initiated.
CONCLUSION: Dissemination is a rare complication of herpes zoster, aided by
immunosuppression. In the presented case there was no evidence of malignancy or
other cause of immunosuppression, but the patient also had type 2 diabetes with
very high blood glucose levels. The diabetes was thought to be causally related
to the ineffective immune response to varicella zoster virus. There has been no
previous published report of this relationship.

Publication Types: 
    Case Reports
    Comparative Study
    English Abstract

PMID: 16479469 [PubMed - indexed for MEDLINE]

551: Rev Med Suisse. 2006 Jan 4;2(47):30-4.

[Infectious disease]

[Article in French]

Erard P.

Departement de medecine Hopital Pourtales 2000 Neuchatel. ph.erard@net2000.ch

Several articles published in 2005 offer new knowledge in infectious diseases
treated by practitioners. This paper discusses viral (influenza) and bacterial
(pneumococci and legionella) respiratory infections. Resistant staphylococci,
different from healthcare-associated MRSA, are now found in community. The
article assesses that epidemics of Norovirus infections are common during winter 
time. The screening for treatment of asymptomatic bacteriuria is not recommended.
The possible development of a successful vaccine to prevent herpes zoster is
finally reminded.

Publication Types: 
    English Abstract
    Review

PMID: 16465942 [PubMed - indexed for MEDLINE]

552: Haematologica. 2005 Dec;90(12 Suppl):EIM04.

Ophthalmic zoster sine herpete presenting as oculomotor palsy after marrow
transplantation for acute myeloid leukemia.

Hon C, Au WY, Cheng VC.

Department of Ophthalmology and Visual Sciences, Lee Kar Shing Specialist Block
Prince of Wales Hospital, Shatin, Hong Kong. honc@ha.org.hk

Publication Types: 
    Case Reports

PMID: 16464763 [PubMed - indexed for MEDLINE]

553: Rev Med Suisse. 2006 Jan 11;2(48):107-8, 111-3.

[Dermatology]

[Article in French]

Kuenzli S, Saurat JH.

We are going over therapeutic acquisitions in a club-journal including relevant
publications in different fields: mecanism of action, therapeutic perspectives in
a near future, and side effects.

Publication Types: 
    English Abstract

PMID: 16463794 [PubMed - indexed for MEDLINE]

554: Rev Chilena Infectol. 2006 Mar;23(1):56-9. Epub 2006 Feb 2.

[Varicella vaccine]

[Article in Spanish]

Abarca Villaseca K.

Facultad de Medicina, Departamento de Pediatria, Unidad de Infectologia,
Pontificia Universidad Catolica de Chile. kabarca@med.puc.cl

Varicella and herpes zoster represent a significant public health problem. Safe
and highly effective varicella vaccines against severe and moderate varicella are
currently available. Vaccine efficacy is lower and more variable against mild
disease and several risk factors have been associated with mild breakthrough
disease. Experts are currently discussing the need for a second vaccine dose.
Universal varicella vaccination has been highly effective in reducing morbidity
and hospitalizations due to varicella, a strategy that has proven to be cost
effective in many regions when the societal-perspective is considered in the
analysis. Recent data suggests that varicella vaccination may be associated with 
an increased incidence of herpes zoster in the elderly. Immunity conferred by
varicella vaccination seems to be longlasting but a continued evaluation is
needed in order to asses the effect of the changing epidemiology associated with 
universal immunization.

Publication Types: 
    English Abstract

PMID: 16462966 [PubMed - indexed for MEDLINE]

555: Am J Ophthalmol. 2006 Feb;141(2):409-12.

Rapid progression of diabetic retinopathy in eyes with posterior uveitis.

Knol JA, van Kooij B, de Valk HW, Rothova A.

Uveitis Center, FC Donders Institute of Ophthalmology, University Medical Center 
Utrecht, Utrecht, The Netherlands.

PURPOSE: To report on two patients who developed rapid progression of asymmetric 
diabetic retinopathy (DRP) in eyes affected by posterior uveitis in contrast to
their fellow eyes not affected by uveitis. DESIGN: Observational case report.
METHODS: Two patients with diabetes mellitus (DM) and unilateral uveitis
underwent repeated ophthalmologic examinations and fluorescein angiography.
RESULTS: Two patients with DM and unilateral posterior uveitis developed
proliferative DRP in eyes with previous uveitis within 3 months after the uveitis
subsided. In contrast, the retinal findings of nonuveitic eyes remained unchanged
on follow-up of several years. CONCLUSIONS: Since the pathogenesis of intraocular
inflammation and diabetic retinopathy acts through similar biochemical mediators 
and pathways, it is feasible that posterior uveitis accelerates the progression
of diabetic retinopathy. Our results support this hypothesis and point out a risk
for rapid retinopathy development in eyes affected with posterior uveitis.

Publication Types: 
    Case Reports

PMID: 16458715 [PubMed - indexed for MEDLINE]

556: Environ Pollut. 2006 Sep;143(2):221-7. Epub 2006 Feb 7.

Cu and Zn adsorption onto non-residual and residual components in the natural
surface coatings samples (NSCSs) in the Songhua River, China.

Li Y, Wang X, Guo S, Dong D.

Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang, Shenyang
110016, PR China. liyuxx@mail.jlu.edu.cn

Natural surface coatings samples (NSCSs) from the surface of river shingles were 
employed to investigate the roles of non-residual and residual components of the 
NSCSs in controlling Cu and Zn adsorption via the selective extraction techniques
and statistical analysis. The results indicate that the greatest contribution to 
metals adsorption on a molar basis was from Mn oxides in the non-residual
fraction. Metals adsorption capacities of Mn oxides exceeded those of Fe oxides
by one order of magnitude, fewer roles were found attributing to adsorption by
organic materials (OM), and the estimated contribution of the residual fraction
to metals adsorption was insignificant. These results implied that Mn oxides were
the most important component in controlling heavy metals in aquatic environments.
Experiments with Cu and Zn adsorption measured together showed that Cu severely
interfered with Zn adsorption to the NSCSs and vice versa under the conditions of
the two coexisted ions adsorption.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16457916 [PubMed - indexed for MEDLINE]

557: Rinsho Ketsueki. 2005 Nov;46(11):1229-32.

[Elderly patient with varicella-zoster virus-associated hemophagocytic syndrome
refractory to steroid therapy]

[Article in Japanese]

Yoshida I, Yoshino T, Takeuchi M.

Division of Hematology, National Hospital Organization, Minami-Okayama Medical
Center.

We experienced a case of virus-associated hemophagocytic syndrome (VAHS) after
varicella-zoster virus (VZV) infection. The patient, a 101-year-old man,
presented with anemia, thrombocytopenia and jaundice two weeks after successful
antiviral treatment for the VZV. Histiocytes were detected in the bone marrow
examination (2.2%); however, hepatomegaly and triglycemia remained unobserved
throughout the course. Reactivation of VZV was detected serologically. The
patient died after five weeks because of persistent cytopenia and liver failure
refractory to steroid treatment. An autopsy revealed hemophagocytosis in the bone
marrow, lung, spleen and liver.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16440810 [PubMed - indexed for MEDLINE]

558: SADJ. 2005 Nov;60(10):432, 436-7.

Herpes zoster post-herpetic neuralgia.

Feller L, Jadwat Y, Bouckaert M.

Department of Periodontology and Oral Medicine, Medunsa Oral Health Centre,
Faculty of Dentistry, University of Limpopo, Medunsa Campus. lfeller@ul.ac.za

Post-herpetic neuralgia (PHN) is the most frequent complication of herpes zoster 
and often results in significant morbidity and a reduction in the patient's
quality of life. The peripheral nerve injury that occurs during the acute phase
of herpes zoster (HZ) leads to an abnormal tonic impulse discharge from primary
nociceptive afferent neurons which induce slow temporal summation.This "wind-up" 
phenomenon is responsible for continuous partial depolarisation of second-order
neurons with increased spontaneous impulse discharge and expanded receptive
fields within the dorsal horn nociceptive neurons.The abnormal central processing
involves the activation of N-methyl-D-aspartate (NMDA) receptors resulting in
neuropathic pain, characterized by spontaneous pain, hyperalgesia and allodynia
which is typical of PHN. In addition, tonic input from non-nociceptive AB
afferent neurons, maintained by sympathetic efferent activity, contribute to the 
development and maintenance of neuropathic pain in general, and a burning
sensation in particular.

PMID: 16438359 [PubMed - indexed for MEDLINE]

559: Br J Dermatol. 2006 Feb;154(2):365-7.

Linear Darier disease with herpes zoster superinfection treated successfully by
brivudine.

Abraham S, Jones A, Toutous-Trellu L, Kerl-Bullani K, Chavaz P, Saurat JH, Piguet
V.

Department of Dermatology and Venereology, University Hospital Geneva, 24 rue
Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.

We report the case of a human immunodeficiency virus-positive patient presenting 
linear Darier disease with varicella-zoster virus superinfection following the
lines of Blaschko. The lesions healed after treatment with brivudine.

Publication Types: 
    Case Reports

PMID: 16433812 [PubMed - indexed for MEDLINE]

560: Br J Anaesth. 2006 Mar;96(3):381-3. Epub 2006 Jan 23.

Repetitive paravertebral nerve block using a catheter technique for pain relief
in post-herpetic neuralgia.

Naja ZM, Maaliki H, Al-Tannir MA, El-Rajab M, Ziade F, Zeidan A.

Department of Anaesthesia and Pain Medicine, Research Unit and Paediatric
Intensive Care, Makassed General Hospital, Beirut, Lebanon. zouhnaja@yahoo.com

We described in this report a case of post-herpetic neuralgia refractory to
medical therapy that was successfully treated with repetitive injections of local
aesthetic mixture (bupivacaine 0.5% 19 ml and clonidine 150 microg ml(-1) 1 ml)
every 48 h for 3 weeks using a paravertebral catheter inserted at T2-T3 level.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16431881 [PubMed - indexed for MEDLINE]

561: Age Ageing. 2006 Mar;35(2):132-7. Epub 2006 Jan 23.

A cross-sectional survey of health state impairment and treatment patterns in
patients with postherpetic neuralgia.

van Seventer R, Sadosky A, Lucero M, Dukes E.

Amphia Ziekenhuis, Department of Anaesthesiology, Breda, The Netherlands.

BACKGROUND: Postherpetic neuralgia (PHN) develops in 8-24% of patients with
herpes zoster. Few studies have evaluated the patient burden and treatment of PHN
in general practice. OBJECTIVES: To determine the patient burden of PHN with
respect to pain intensity and impact on patient functioning and to characterise
treatment patterns and health resource utilisation in general practice. METHODS: 
Eighty-four patients with PHN were identified in general practice settings during
an observational survey of neuropathic pain syndromes in six European countries. 
Patients answered a questionnaire that included: pain severity and interference
items from the modified short form brief pain inventory (mBPI-SF); EuroQol
(EQ-5D) survey; and questions related to current treatment, health status and
resource utilisation. Physicians provided information on medications prescribed
for PHN and pain-related co-morbidities (anxiety, depression and sleep
disturbance). RESULTS: Mean patient age was 71.0 +/- 12.8 years, 76% were > or = 
65 years and 45% of patients had PHN > or = 1 year. The mean pain severity index 
was 4.2, reflecting moderate pain despite 89% of patients taking prescription
medications for PHN. Few medications with demonstrated efficacy against PHN (e.g.
carbamazepine and gabapentin) were prescribed, often at suboptimal doses. Pain
severity was associated with reduced EQ-5D health state valuation (P<0.001),
greater pain interference on all domains (P<0.001) and increased health resource 
utilisation (P = 0.008). CONCLUSIONS: PHN causes substantial patient burden
expressed as interference with daily functioning and reduced health status
associated with pain severity. This burden may result in part from suboptimal
management strategies and suggests a need for more effective pain management.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16431855 [PubMed - indexed for MEDLINE]

562: Clin Rheumatol. 2007 May;26(5):779-80. Epub 2006 Jan 21.

Remission of rheumatoid arthritis after acute disseminated varicella-zoster
infection.

Agarwal V, Singh R, Chauhan S.

Department of Medicine, Government Medical College & Hospital, Chandigarh, India.
vikasagr@sgpgi.ac.in

A 65-year-old immunocompetent male presented with symmetric polyarthritis of 12
weeks and paresthesias in the distribution of the left median nerve distribution 
of 4 weeks duration. He had tender joint count of 20 and swollen joint count of
12. He was positive for rheumatoid factor and his erythrocyte sedimentation rate 
was 52 mm. Nerve conduction study demonstrated polyneuropathy. Radiographs showed
severe juxta articular osteopenia at the wrist and the metacarpophalangeal
joints. He received methotrexate of 10 mg/week and prednisolone of 0.15 mg/kg/day
along with nonsteroidal antiinflammatory drugs (NSAIDs) with a diagnosis of
seropositive rheumatoid arthritis (RA). Thirteen weeks after therapy, he
presented to the outpatient clinic with disseminated vesicular eruptions all over
his body with erythematous base and pneumonia involving the left upper lobe.
Tzanck smear from the lesions and serology (IgG) for varicella-virus infection
were positive. A diagnosis of acute disseminated varicella zoster with pneumonia 
was made. The patient improved on parenteral acyclovir and broad-spectrum
antibiotics. With the improvement in rash and pneumonia after 2 weeks, the
patient noticed a marked improvement in the joint symptoms. Arthritis remained in
remission without the need for any disease-modifying drug or NSAID for next the
24 months and continued to be so until the last follow-up. Our case presents a
unique phenomenon of RA remission after disseminated varicella-zoster infection
in an immunocompetent individual.

Publication Types: 
    Case Reports

PMID: 16429237 [PubMed - indexed for MEDLINE]

563: Eur J Pain. 2006 Nov;10(8):695-700. Epub 2006 Jan 20.

Predicting and preventing post-herpetic neuralgia: are current risk factors
useful in clinical practice?

Coen PG, Scott F, Leedham-Green M, Nia T, Jamil A, Johnson RW, Breuer J.

Queen Mary's School of Medicine and Dentistry, University of London, Department
of Medical Microbiology, 25-29 Ashfield Street, London E1 1BB, UK.

Post-herpetic neuralgia (PHN) following acute herpes zoster remains a significant
cause of neuropathic pain especially in the elderly. Early treatment of the
zoster rash with antiviral agents, such as aciclovir remains one of the few
measures proven to reduce the incidence and duration of PHN albeit only in a
subset of patients. It is therefore crucial that the physician who first sees a
case of zoster identifies those patients who are most likely to develop long-term
pain and treats them accordingly. In particular, prodrugs such as famciclovir and
valaciclvoir may be more beneficial in reducing PHN than the shorter acting
aciclovir, but can be more expensive. Measures that could be used to predict
patients likely to develop PHN would also facilitate the evaluation of early use 
of antiepileptic, anti-inflammatory and analgesic agents in the prevention of
PHN. In a prospective study of 280 herpes zoster (HZ) cases seen by the general
practitioner (GP) we evaluated the predictive value of five clinical factors
identified in clinical trials as associated with a higher likelihood of PHN. A
visual analogue score (VAS) over 5 and/or age over 50 correctly identified all
subjects with PHN at 3 and 6 months, respectively. However, the specificity of
this prediction was low because as many as 81% and 85% of those aged over 50
recovered within 3 and 6 months, respectively. Better methods are needed to
identify patients over 50 at most risk of PHN that enable GPs to better allocate 
their resources with respect to HZ treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16427792 [PubMed - indexed for MEDLINE]

564: Clin Nucl Med. 2006 Feb;31(2):104-5.

Herpes Zoster mimicking recurrence of lymphoma on PET/CT.

Joyce JM, Carlos T.

Division of Nuclear Medicine, Department of Radiology, University of Pittsburgh
Medical Center, Pittsburgh, PA 15213, USA. joycejm@upmc.edu

Publication Types: 
    Case Reports

PMID: 16424700 [PubMed - indexed for MEDLINE]

565: Ann Dermatol Venereol. 2005 Oct;132(10 Suppl):7S28-7S34.

[Item no 84: herpes virus infections in immunocompetent children and adults:
varicella and zona]

[Article in French]

[No authors listed]

PMID: 16419517 [PubMed - indexed for MEDLINE]

566: Dev Med Child Neurol. 2006 Feb;48(2):139-42.

Post-varicella intracranial haemorrhage in a child.

Danchaivijitr N, Miravet E, Saunders DE, Cox T, Ganesan V.

Department of Radiology, Great Ormond Street Hospital, UK.

We report a case of a 7-month-old male with primary intracranial haemorrhage 2
months after infection with varicella zoster virus (VZV). His initial clinical
course was complicated by seizures and right hemiparesis; when last seen at 22
months the only positive finding was of left hand preference. Although the
literature has recently established the association of arterial ischaemic stroke 
and VZV infection, primary intracranial haemorrhage has been reported only in one
case. The child reported here had anterior interhemispheric haemorrhage due to a 
focal arteritis of the left anterior cerebral artery. The vascular abnormality
was transient and had radiological features compatible with either a focal
arteritis or vasospasm as a direct result of blood surrounding the vessels. We
postulate that direct invasion of VZV caused extensive inflammation of the vessel
wall and aggressive tissue penetration resulting in necrotizing angiitis and
intracranial haemorrhage. We suggest that VZV infection should be considered a
potential risk factor for intracranial haemorrhage in children.

Publication Types: 
    Case Reports

PMID: 16417671 [PubMed - indexed for MEDLINE]

567: J AAPOS. 2005 Dec;9(6):597-8.

Herpes zoster ophthalmicus in an otherwise-healthy child.

Binder NR, Holland GN, Hosea S, Silverberg ML.

Sansum Santa Barbara Medical Foundation Clinic, Santa Barbara, California 93101, 
USA.

Herpes zoster ophthalmicus, although not uncommon in adults, is rarely found in
children. Herein we present a case of pediatric herpes zoster ophthalmicus that
is unique in 2 ways. First, the child had been vaccinated against varicella and
otherwise had no known exposure to varicella-zoster virus. Second, the initial
presentation of herpes zoster ophthalmicus was a painful and diffuse
subconjunctival hemorrhage that appeared before any of its classic signs were
observed. We report this case to document the possible occurrence of herpes
zoster ophthalmicus in children who have been vaccinated against varicella and
the possibility of a diffuse, painful subconjunctival hemorrhage as a presenting 
sign.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16414532 [PubMed - indexed for MEDLINE]

568: Dermatol Online J. 2005 Dec 1;11(3):26.

Dermatomal vesicular eruption in an asymptomatic infant.

Bhushan P, Sardana K, Mahajan S.

Department of Dermatology and STD, Lady Hardinge Medical College, KSCH Hospital, 
New Delhi, India.

We present a case of infantile herpes zoster without clinical evidence of
varicella infection in the mother or apparent exposure in the child; our
patient's diagnosis was confirmed by serology and by Tzanck smear. We briefly
review the etiopathogenesis factors of this condition. We emphasize the benign
course and spontaneous uneventful resolution.

Publication Types: 
    Case Reports

PMID: 16409922 [PubMed - indexed for MEDLINE]

569: Dermatol Online J. 2005 Dec 1;11(3):8.

Infections in the elderly.

Scheinfeld N.

St Lukes Roosevelt Hospital Center, New York, USA. NSS32@Columbia.edu

As people age they experience more illness and this applies in particular to skin
infections. Pathogenic states that provide the milieu for infection are more
common in the elderly. Infections that occur more common in the elderly include
Gram-positive bacterial infections of the skin, intertriginous infections, herpes
zoster/shingles and onychomycosis. These will be reviewed in the article. Newer
treatments such as valacyclovir, famcyclovir, terbinafine and linezolid exist to 
treat these infections. Recognizing the varying presentations enhances the health
and treatment of disease of elderly patients.

Publication Types: 
    Review

PMID: 16409904 [PubMed - indexed for MEDLINE]

570: Skin Therapy Lett. 2005 Dec-2006 Jan;10(10):5-7.

Famciclovir for the treatment of recurrent genital and labial herpes lesions.

Langley RG.

Division of Dermatology, Department of Medicine, and Centre for Clinical
Research, Dalhousie University, Halifax, NS, Canada.

Famciclovir (Famvir, Novartis) is an effective treatment for herpes zoster and
herpes simplex. Two separate studies recently examined the effectiveness of
single high doses of famciclovir for treating recurrent genital herpes and labial
herpes (cold sores). In the randomized, placebo-controlled studies, patients
initiated treatment at the first onset of symptoms. For the treatment of genital 
herpes, a 1,000 mg b.i.d. dose of famciclovir had significant advantages over the
placebo, reducing the time required to heal the lesions, preventing the
development of lesions beyond the papule stage, and improving the time to
resolution of all symptoms. For the treatment of labial herpes, a single 1,500 mg
dose of famciclovir shortened the lesion healing time, shortened the time to
normal skin, and resulted in faster resolution of pain and tenderness.

PMID: 16408140 [PubMed - indexed for MEDLINE]

571: J Athl Train. 2005 Oct-Dec;40(4):365-9.

Celiac disease symptoms in a female collegiate tennis player: a case report.

Leone JE, Gray KA, Massie JE, Rossi JM.

Department of Physical Education, Southern Illinois University at Carbondale,
1075 S. Normal Avenue, Carbondale, IL 62901-4310, USA. Jleone@siu.edu

OBJECTIVE: To present the case of a collegiate tennis player with celiac disease 
symptoms. BACKGROUND: Celiac disease is a common intestinal disorder that is
often confused with other conditions. It causes severe intestinal damage
manifested by several uncomfortable signs and symptoms. Failure by the sports
medicine staff to recognize symptoms consistent with celiac disease and treat
them appropriately can have deleterious consequences for the athlete.
DIFFERENTIAL DIAGNOSIS: Irritable bowel syndrome, Crohn disease, Addison disease,
lupus erythematosus, juvenile rheumatoid arthritis, lactose intolerance, herpes
zoster, psychogenic disorder (depression), fibromyalgia, complex regional pain
syndrome, hyperthyroidism, anemia, type I diabetes. TREATMENT: The athlete
underwent a series of blood and allergen tests to confirm or refute a diagnosis
of celiac disease. When celiac disease was suspected, dietary modifications were 
made to eliminate all wheat-based and gluten-based products from the athlete's
diet. UNIQUENESS: The athlete was able to fully compete in a competitive National
Collegiate Athletic Association Division I tennis program while experiencing the 
debilitating effects associated with celiac disease. The immediacy of symptom
onset was notable because the athlete had no history of similar complaints.
CONCLUSIONS: Celiac disease is a potentially life-threatening condition that
affects more people than reported. A properly educated sports medicine staff can 
help to identify symptoms consistent with celiac disease early, so damage to the 
intestine is minimized. Prompt recognition and appropriate management allow the
athlete to adjust the diet accordingly, compete at a high-caliber level, and
enjoy a healthier quality of life.

PMID: 16404460 [PubMed]

572: Clin Experiment Ophthalmol. 2005 Dec;33(6):636-8.

Herpes zoster ophthalmicus: presenting as giant-cell arteritis.

de Castro LE, Petersen AM, Givre SJ, Solomon KD, Vroman DT.

Magill Research Center for Vision Correction, Storm Eye Institute, Medical
University of South Carolina, Charleston, SC 29425, USA.

A 74-year-old woman was referred to the authors' clinic with a 1-week suspicion
of giant-cell arteritis. Uncomplicated, bilateral temporal artery biopsies were
performed 3 days after admission for therapy. Four hours after the procedure she 
developed vesicular lesions of the face compatible with herpes zoster
ophthalmicus. The temporal artery biopsy revealed perineural lymphocytic
aggregation. Both giant-cell arteritis and herpes zoster ophthalmicus form part
of the differential diagnosis in elderly patients with headache. In such cases,
clues from a temporal artery biopsy may aid in diagnosis of herpes zoster. In
addition, the patient in this case developed the rash 10 days after onset of
symptoms, which is rare as the average time from onset of symptoms to rash in
zoster is 3-5 days.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16402958 [PubMed - indexed for MEDLINE]

573: MMW Fortschr Med. 2005 Dec 8;147(49-50):76-8.

[Neuropathic pain]

[Article in German]

Ludwig J, Baron R.

Sektion Neurologische Schmerzforschung und Therapie, Klinik fur Neurologie,
Universitatsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 10,
D-24105 Kiel. j.ludwig@neurologie.uni-kiel.de

Arises after an injury to nociceptive systems. Examples of the most common causes
are polyneuropathies, acute zoster neuralgia, and postherpetic neuralgia. The
differential diagnosis and management are discussed.

Publication Types: 
    English Abstract

PMID: 16401018 [PubMed - indexed for MEDLINE]

574: J Paediatr Child Health. 2005 Nov;41(11):544-52.

Comment in:
    J Paediatr Child Health. 2005 Nov;41(11):541-2.

Varicella vaccination in Australia.

Macartney KK, Beutels P, McIntyre P, Burgess MA.

National Centre for Immunisation Research and Surveillance of Vaccine Preventable
Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales,
Australia. kristinm@chw.edu.au

Varicella zoster virus (VZV) causes both chickenpox and herpes zoster and is
responsible for a significant disease burden, including hospitalizations and
deaths, in Australian children and adults. Varicella vaccine has been available
in Australia for 5 years; however, from November 2005, it will be funded for use 
in all susceptible children at 18 months and 10-13 years of age under the
National Immunisation Program. Experience with universal varicella vaccination of
children in the USA over the last 10 years has shown that the vaccine is safe and
highly effective in reducing varicella-related disease. This review summarizes
the epidemiology of VZV-related disease in Australia, the use of varicella
vaccine and the international experience with vaccine efficacy and safety. The
potential impact of varicella vaccination on the incidence of herpes zoster is
also discussed.

Publication Types: 
    Review

PMID: 16398834 [PubMed - indexed for MEDLINE]

575: Acta Ophthalmol Scand. 2005 Dec;83(6):758-60.

Peripheral retinal changes in acute retinal necrosis imaged by ultra widefield
scanning laser ophthalmoscopy.

Neubauer AS, Yu A, Haritoglou C, Ulbig MW.

Publication Types: 
    Case Reports
    Letter

PMID: 16396659 [PubMed - indexed for MEDLINE]

576: Pediatr Infect Dis J. 2006 Jan;25(1):53-8.

Immune reconstitution syndrome after highly active antiretroviral therapy in
human immunodeficiency virus-infected thai children.

Puthanakit T, Oberdorfer P, Akarathum N, Wannarit P, Sirisanthana T, Sirisanthana
V.

Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

BACKGROUND: There is little information about the immune reconstitution syndrome 
(IRS) in children, especially from resource-poor countries. OBJECTIVE: To
determine the incidence and spectrum of IRS in advanced stage human
immunodeficiency virus (HIV)-infected children after initiation of highly active 
antiretroviral therapy (HAART). METHODS: Between May 2002 and April 2004, 153
symptomatic HIV-infected children who had CD4 lymphocyte percentage < or =15%
initiated HAART in a national antiretroviral drug access program. All patients
were followed for 48 weeks. In this study, IRS was defined as a disease event
caused by microorganisms or conditions previously reported to be associated with 
IRS in patients having immunologic and/or virologic response to HAART. RESULTS:
The incidence of IRS was 19% (95% confidence interval, 13.1-26.1). The median
time of onset was 4 weeks after start of HAART (range, 2-31). There were 32
episodes of IRS, including 14 caused by mycobacterial organisms, 7 by
varicella-zoster virus, 7 by herpes simplex virus, 3 by Cryptococcus neoformans
and 1 episode of Guillain-Barre syndrome. Patients who had IRS develop had lower 
baseline CD4 lymphocyte percentages compared with those who did not (P = 0.02).
CONCLUSIONS: IRS is common among HIV-infected children who received HAART in
their advanced stage of disease. Educational programs for patients and health
care workers on recognizing and treating these conditions should be integrated
into antiretroviral treatment access programs.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16395104 [PubMed - indexed for MEDLINE]

577: Indian J Dermatol Venereol Leprol. 2005 May-Jun;71(3):210-1.

Multidermatomal herpes zoster in an immunocompetent female.

Gupta LK, Kuldeep CM, Mittal A, Singhal H.

Publication Types: 
    Case Reports
    Letter

PMID: 16394421 [PubMed - indexed for MEDLINE]

578: Herpes. 2005 Dec;12(3):59.

Varicella immunization and herpes zoster.

Volpi A.

Publication Types: 
    Editorial

PMID: 16393520 [PubMed - indexed for MEDLINE]

579: Transpl Infect Dis. 2005 Sep-Dec;7(3-4):116-21.

Comment in:
    Transpl Infect Dis. 2005 Sep-Dec;7(3-4):97-8.

Retrospective analysis of varicella zoster virus (VZV) copy DNA numbers in plasma
of immunocompetent patients with herpes zoster, of immunocompromised patients
with disseminated VZV disease, and of asymptomatic solid organ transplant
recipients.

Kronenberg A, Bossart W, Wuthrich RP, Cao C, Lautenschlager S, Wiegand ND,
Mullhaupt B, Noll G, Mueller NJ, Speck RF.

Division of Infectious Diseases and Hospital Epidemiology, Department of Internal
Medicine, University Hospital of Zurich, Zurich, Switzerland.

BACKGROUND: Varicella zoster virus (VZV) causes significant morbidity and
mortality in immunocompromised patients. Subclinical reactivation has been
described in solid organ recipients and has been associated with graft versus
host disease in bone marrow transplantation. Newer studies assessing the
prevalence and impact of subclinical VZV reactivation in solid organ transplant
(SOT) recipients are lacking. METHODS AND RESULTS: In a first step we developed a
highly sensitive quantitative polymerase chain reaction (qPCR) assay for VZV DNA 
with a detection limit of < or = 20 copies/mL. Using this assay, we
retrospectively analyzed plasma samples of different patient groups for VZV DNA. 
VZV DNA was found in 10/10 plasma samples of immunocompetent patients with herpes
zoster (VZV copy numbers/mL: mean+/-SEM 1710+/-1018), in 1/1 sample of a human
immunodeficiency virus-infected patient with primary VZV disease (15,192
copies/mL) and in 4/4 plasma samples of immunocompromised patients with visceral 
VZV disease (mean of first value 214,214+/-178,572). All 108 plasma samples of
asymptomatic SOT recipients off any antiviral therapy, randomly sampled over 1
year, were negative for VZV DNA. CONCLUSION: Our qPCR assay proved to be highly
sensitive (100%) in symptomatic VZV disease. We did not detect subclinical
reactivation in asymptomatic SOT recipients during the first post-transplant
year. Thus, subclinical VZV reactivation is either a rare event or does not
exist. These data need to be confirmed in larger prospective trials.

Publication Types: 
    Evaluation Studies

PMID: 16390399 [PubMed - indexed for MEDLINE]

580: Stat Med. 2006 Jan 30;25(2):359-60.

Comment on:
    Stat Med. 2001 Aug 30;20(16):2429-39.

Phase specific analysis of herpes zoster associated pain data: a new statistical 
approach by R. B. Arani, S.-J. Soong, H. L. Weiss, M. J. Wood, P. A. Fiddian, J. 
W. Gnann and R. Whitley, Statistics in Medicine 2001; 20:2429-2439.

Kay R.

Publication Types: 
    Comment
    Letter

PMID: 16381077 [PubMed - indexed for MEDLINE]

581: Am J Med. 2005 Dec;118(12):1416.

Herpes zoster in immunocompromised patients: incidence, timing, and risk factors.

Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, Min YI, Merkel PA, Spiera
R, Davis JC, St Clair EW, McCune J, Ytterberg SR, Allen NB, Stone JH; WGET
Research Group.

Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore,
Md, USA.

PURPOSE: To evaluate the risk factors for herpes zoster as well as the incidence 
and timing of this complication in patients who were treated with
immunosuppression because of active Wegener's granulomatosis. SUBJECTS AND
METHODS: We studied the 180 Wegener's granulomatosis patients in the Wegener's
Granulomatosis Etanercept Trial (WGET). Herpes zoster events during WGET were
documented prospectively. Follow-up questionnaires were employed to describe the 
location, treatment, and complication(s) of herpes zoster and its therapy.
Univariate and multivariate analyses were performed to evaluate risk factors,
including history of herpes zoster, for the occurrence of herpes zoster during
the trial. All analyses were based on the time to first occurrence of herpes
zoster. RESULTS: Eighteen patients (10% of the WGET cohort) suffered a total of
19 herpes zoster episodes over a mean follow-up period of 27 months. The annual
incidence of herpes zoster in the WGET cohort was 45 cases/1000 patient-years
(95% confidence interval [CI]: 27, 70). The median time from enrollment to the
occurrence of herpes zoster in the subgroup of patients with that complication
was 16.5 months (+/- 9.4). Fifteen of the 19 herpes zoster events (79%) occurred 
between months 6 and 36, many months after the period of most intensive
immunosuppression. In univariate analyses, history of serum creatinine > or =1.5 
mg/dL before enrollment was associated with a relative risk (RR) of 3.0 (95% CI: 
1.1, 7.8) for herpes zoster during WGET (P=.03). In multivariate analyses, serum 
creatinine > or =1.5 mg/dL was associated with an RR of 6.3 (95% CI: 2.0, 19.8;
P=.002), and female sex with an RR of 4.6 (95% CI: 1.6, 13.2; P=.004).
CONCLUSION: Renal dysfunction and female sex were consistently strong risk
factors for herpes zoster events in this population. Contrary to expectation,
most herpes zoster events did not occur during periods of most intensive
immunosuppression. These data may inform studies of interventions designed to
prevent herpes zoster in patients on treatment for immune-mediated diseases.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16378799 [PubMed - indexed for MEDLINE]

582: MedGenMed. 2005 Jul 13;7(3):63.

A 26-year-old woman presented to Kijabe Mission Hospital with a diffuse rash and 
dyspnea.

Fielder JF.

Africa Inland Church Kijabe Hospital, Kijabe, Kenya, Africa. jfielder@kijabe.net

Publication Types: 
    Case Reports

PMID: 16369289 [PubMed - indexed for MEDLINE]

583: Jpn J Ophthalmol. 2005 Nov-Dec;49(6):536-8.

Herpes zoster panuveitis progression despite acyclovir treatment in a patient
following bone marrow transplantation.

Fujiwara O, Mitamura Y, Ohtsuka K.

Publication Types: 
    Case Reports
    Letter

PMID: 16365806 [PubMed - indexed for MEDLINE]

584: J Dermatol. 2005 Nov;32(11):933-4.

Sequential development of herpes zoster duplex unilateralis during oral
famciclovir treatment.

Goo B, Cho SB, Chung KY.

Publication Types: 
    Case Reports
    Letter

PMID: 16361760 [PubMed - indexed for MEDLINE]

585: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Jan;101(1):70-5. Epub
2005 Oct 5.

Mandibular osteomyelitis and tooth exfoliation following zoster-CMV co-infection.

Meer S, Coleman H, Altini M, Alexander T.

Division of Oral Pathology, Department of Anatomical Pathology, University of the
Witwatersrand, Johannesburg, South Africa. shabnum.meer@nhls.ac.za

Herpes zoster is a common viral infection, the oral soft tissue manifestations of
which are widely known and recognized. Reports of spontaneous tooth exfoliation
and jaw osteonecrosis following herpes zoster infection in the distribution of
the trigeminal nerve are extremely infrequent and sporadic, with only 39 cases
being reported in the literature. We report an additional case of mandibular
osteomyelitis and spontaneous tooth exfoliation following herpes zoster
infection, which occurred in the left mandible of a 70-year-old diabetic man;
however, our case also showed CMV co-infection. The role of CMV in the
pathogenesis of the osteonecrosis remains uncertain. Awareness of the possibility
of CMV co-infection in various oral diseases including oral ulcers, Kaposi's
sarcoma, and herpes zoster infections especially in immunocompromised patients is
important, since spread of the CMV can easily occur to other sites with
potentially fatal consequences. Early diagnosis can lead to effective treatment
and prevention of complications.

Publication Types: 
    Case Reports

PMID: 16360610 [PubMed - indexed for MEDLINE]

586: Mikrobiyol Bul. 2005 Jul;39(3):339-43.

[Short communication: retrospective analysis of 21 HIV/AIDS cases]

[Article in Turkish]

Akalin H, Heper Y, Yilmaz E, Kazak E, Oral B, Mistik R, Helvaci S, Tore O.

Uludag Universitesi Tip Fakultesi Mikrobiyoloji ve Enfeksiyon Hastaliklari
Anabilim Dali, Bursa.

In this study, 21 HIV/AIDS cases (18 male, 3 female; age range 17-64 years),
followed up in the Department of Infectious Diseases of Uludag University Medical
Faculty between 1997-2003 have been analyzed retrospectively, by means of
epidemiological, clinical and laboratory aspects. Nineteen (90%) of them were
heterosexual, and in 9 cases the diagnosis was coincidental during the blood
donations or routine testing. The non-compliance rate of patients to
antiretroviral treatment was found as 76%, and the most important factor for
non-compliance was the difficulty in providing antiretroviral drugs. The most
frequently encountered opportunistic infections were oropharyngeal candidiasis
(n:5), herpes zoster (n:4) and community acquired pneumonia (n:4).

Publication Types: 
    English Abstract

PMID: 16358494 [PubMed - indexed for MEDLINE]

587: Vaccine. 2006 Feb 27;24(9):1308-14. Epub 2005 Sep 30.

The burden of Herpes Zoster: a prospective population based study.

Scott FT, Johnson RW, Leedham-Green M, Davies E, Edmunds WJ, Breuer J.

Skin Virus Laboratory, Institute for Cell and Molecular Science, 25-29 Ashfield
Street, E1 1BB, UK.

We analysed prospectively the medical, societal and economic burden among
patients from 18 general practices in East London, serving 158,716 patients who
presented to their general practitioners with acute Herpes Zoster over an 8-month
period. One hundred and eighty-six patients with HZ were seen by GPs during the
study period, of whom 96 were referred, 70 enrolled and 65 completed. PHN
occurred in 13.4% of patients. The average overall cost of HZ in the first 6
months was calculated at pound524 per patient. Medical costs were highest in
those aged over 65 and societal costs highest in those aged under 65 years.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16352376 [PubMed - indexed for MEDLINE]

588: BMC Fam Pract. 2005 Dec 14;6:50.

A rare case of disseminated cutaneous zoster in an immunocompetent patient.

Gupta S, Jain A, Gardiner C, Tyring SK.

Department of Medicine, University of Texas Health Science Center at Houston,
6431 Fannin, Houston 77030, USA. sachin.gupta@uth.tmc.edu

BACKGROUND: Disseminated cutaneous herpes zoster in healthy persons is uncommon, 
though it has been described in immunocompromised patients. CASE PRESENTATION: We
describe a case of disseminated cutaneous herpes zoster in an elderly man with no
apparent immunosuppressive condition. The patient was treated successfully with
intravenous Acyclovir. CONCLUSION: We suggest that disseminated zoster can occur 
in an immunocompetent host and should be promptly recognized and treated to
prevent serious complications.

Publication Types: 
    Case Reports

PMID: 16351732 [PubMed - indexed for MEDLINE]

589: Ultrasound Q. 2005 Dec;21(4):295-308.

Ultrasound markers of fetal infection part 1: viral infections.

Bailao LA, Osborne NG, Rizzi MC, Bonilla-Musoles F, Duarte G, Bailao TC.

Department of Obstetrics and Gynecology, School of Medicine, University of Sao
Paulo, Brazil.

Diagnosis of fetal infection has depended on identification of pathogens by means
of microbiological cultures, immunologic techniques, and special molecular
biology techniques that can identify organisms known or suspected of being
associated with adverse outcomes of pregnancy. Rubella, cytomegalovirus (CMV),
herpes simplex virus (HSV), and human immunodeficiency virus (HIV), for example, 
are capable of gaining access to the amniotic cavity and producing fetal
infection, even when amniotic membranes are intact. Intrauterine invasion by
viruses can be associated with maternal symptoms of infection or can be
completely silent. In many instances extensive fetal compromise with irreversible
structural damage or fetal death will have occurred by the time infection is
confirmed by culture or other histopathological methods. The evidence of fetal
infection may be as subtle as nascent intrauterine growth restriction (IUGR),
mildly inappropriate calcification of fetal organs, placenta, cord, and
membranes, and failure to adequately develop fetal fat reserves. The evidence of 
infection may be as dramatic as obvious fetal malformation, severe central
nervous system structural damage, or fetal death. Sonography is capable of
detecting most of the grave alterations and some of the subtle effects that are
typical of fetal infection.

Publication Types: 
    Comparative Study
    Review

PMID: 16344748 [PubMed - indexed for MEDLINE]

590: Neurology. 2005 Dec 13;65(11):1812.

MRI of trigeminal zoster.

Aribandi M, Aribandi L.

Department of Radiology, Geisinger Medical Center, Danville, PA 17822, USA.
maribandi1@geisinger.edu

Publication Types: 
    Case Reports

PMID: 16344530 [PubMed - indexed for MEDLINE]

591: Kinderkrankenschwester. 2005 Nov;24(11):478-9.

[News from the "vaccine kitchen": herpes zoster, measles, mumps, rubella and
varicella, rotaviruses, papillomaviruses]

[Article in German]

Deutsches Grunes Kreuz e.V.

PMID: 16334650 [PubMed - indexed for MEDLINE]

592: CMAJ. 2005 Dec 6;173(12):1490; author reply 1490.

Comment on:
    CMAJ. 2005 Jul 5;173(1):33.

Giant cell arteritis.

Varnholt H.

Publication Types: 
    Comment
    Letter

PMID: 16330647 [PubMed - indexed for MEDLINE]

593: Int J Epidemiol. 2006 Apr;35(2):307-14. Epub 2005 Dec 5.

Micronutrient intake and the risk of herpes zoster: a case-control study.

Thomas SL, Wheeler JG, Hall AJ.

Department of Infectious and Tropical Diseases, London School of Hygiene and
Tropical Medicine, London, UK. sara.thomas@lshtm.ac.uk

BACKGROUND: Herpes zoster can seriously impair quality of life and may also be a 
marker for age-related immune decline (immunosenescence). Diets low in
micronutrients may increase the risk of zoster by temporarily compromising
cell-mediated immune function or by hastening immunosenescence. METHODS: Primary 
objectives were to examine the association between risk of zoster and (i) dietary
intake of vitamins A, B(6), C, E, folic acid, zinc, and iron, and (ii) fruit and 
vegetable consumption. We conducted a community-based case-control study. Cases
were adults with incident zoster presenting to 22 general practices in London.
Controls were individuals with no zoster history, matched to cases by age, sex,
and general practice. Diet was ascertained for 243 cases and 483 controls using
an interviewer-administered food-frequency questionnaire. We used conditional
logistic regression to estimate odds ratios. RESULTS: There was a strong graded
association between lower fruit intake and increasing zoster risk; in adjusted
analysis, individuals who ate less than one piece of fruit per week had more than
three times the risk of zoster compared with individuals who ate more than three 
portions per day. None of the dietary intakes of the seven micronutrients
examined had a statistically significant association with zoster risk when
considered singly. However, amongst individuals aged >60 years, a measure of
combined micronutrient intake and vegetable intake showed similar dose-related
associations with zoster risk. CONCLUSION: A cocktail of nutrients such as those 
found in fruit and vegetables may act together, particularly in older
individuals, to maintain immune health and prevent zoster.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 16330478 [PubMed - indexed for MEDLINE]

594: Postgrad Med. 2005 Nov;118(5):45-8, 51-4.

Viral infections in the elderly. The challenges of managing herpes zoster,
influenza, and RSV.

Bader MS, McKinsey DS.

Memorial University of Newfoundland Health Sciences Center, St John's, Canada.
msbader1@hotmail.com

Viral diseases are an important cause of morbidity and mortality in elderly
patients, whether they live in the community or in long-term care facilities.
Management of viral infections in older adults is complicated by factors that
include the infrequency or absence of common signs and symptoms of infection and 
adverse drug reactions. In this article, Drs Bader and McKinsey discuss the
clinical features and treatment of herpes zoster and the respiratory diseases
caused by influenza and respiratory syncytial virus (RSV).

Publication Types: 
    Review

PMID: 16329530 [PubMed - indexed for MEDLINE]

595: J Pain. 2005 Dec;6(12):782-90.

Psychosocial risk factors for postherpetic neuralgia: a prospective study of
patients with herpes zoster.

Katz J, McDermott MP, Cooper EM, Walther RR, Sweeney EW, Dworkin RH.

Department of Anesthesiology, University of Rochester School of Medicine and
Dentistry, Rochester, NY 14642, USA.

The results of previous studies using retrospective methods or small samples have
suggested that there may be psychosocial risk factors for postherpetic neuralgia 
(PHN). We conducted a prospective study in which 110 patients with herpes zoster 
were assessed within the first month after rash onset with measures of acute pain
and five broad domains of psychosocial functioning-physical, role, social, and
emotional functioning, and stress and social support. Twenty of the 102 patients 
with follow-up data were diagnosed with PHN, defined as pain that had persisted
for 4 months after rash onset. Measures of role functioning, personality disorder
symptoms, and disease conviction during herpes zoster each made independent
contributions to predicting either presence or intensity of PHN in logistic and
linear regression analyses that controlled for relevant demographic and clinical 
variables, including age and acute pain intensity. These findings indicate that
psychosocial variables are risk factors for the development of PHN. PERSPECTIVE: 
The results of this prospective study of patients with herpes zoster suggest that
future research on the mechanisms and prevention of PHN should consider
psychosocial as well as neurobiologic processes.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16326366 [PubMed - indexed for MEDLINE]

596: J Ayub Med Coll Abbottabad. 2005 Jul-Sep;17(3):80-1.

Recurrence of herpes zoster in an immunocompetent adult male.

Raza N, Iqbal P, Anwer J.

Combined Military Hospital, Abbottabad. naeemraza561@hotmail.com

Repeated and disseminated eruptions herpes zoster are frequently detected in
immunocompromised patients, but are rare in immuno-competent individuals. We
report a case of recurrent herpes zoster in a young healthy male, who redeveloped
herpes zoster in a different dermatome after one year.

Publication Types: 
    Case Reports

PMID: 16320806 [PubMed - indexed for MEDLINE]

597: SADJ. 2005 Oct;60(9):386-7.

Eye signs that alert the clinician to a diagnosis of AIDS.

Meyer D.

Department of Ophthalmology, University of Stellenbosch. dm2@sun.ac.za

One of the hallmarks of progressive immune deficiency is a steady decline in the 
absolute number of CD4+ T-lymphocytes. As the immune response thus becomes
suppressed, opportunistic systemic infections such as protozoal (Pneumocystis
carinii pneumonia, disseminated toxoplasmosis), viral (Cytomegalovirus
pneumonitis and colitis and persistent invasive herpes simplex lesions), fungal
(cryptococcossis and esophageal candidiasis) and bacterial infections (atypical
mycobacterial and extrapulmonary tuberculosis) set in to claim their toll. Ocular
complications occur in about 75% of AIDS patients and may be divided into four
categories: Retinal microangiopathy, Opportunistic infections, Tumours,
Neuro-ophthalmological lesions. Only the most frequently occurring manifestations
will be highlighted.

PMID: 16320530 [PubMed - indexed for MEDLINE]

598: SADJ. 2005 Oct;60(9):380-2, 384.

Herpes zoster: a review of the literature and report of a case.

Feller L, Jadwat Y.

Department of Periodontology and Oral Medicine, Medunsa Oral Health Centre,
Faculty of Dentistry, Medunsa Campus, University of Limpopo. lfeller@ul.ac.za

Publication Types: 
    Case Reports
    Review

PMID: 16320529 [PubMed - indexed for MEDLINE]

599: Br J Dermatol. 2005 Dec;153(6):1241-3.

Erythema annulare centrifugum following herpes zoster infection: Wolf's isotopic 
response?

Lee HW, Lee DK, Rhee DY, Chang SE, Choi JH, Moon KC, Koh JK.

Publication Types: 
    Case Reports
    Letter

PMID: 16307675 [PubMed - indexed for MEDLINE]

600: Eye. 2005 Oct;19(10):1035-6.

Comment in:
    Eye. 2006 Dec;20(12):1414-5; author reply 1415.

Management of blinding disease: loss of immunity and superinfection.

Evans BG.

Communicable Disease Surveillance Centre, London, UK. barry.evans@hpa.org.uk

Globally the most important loss of immunity currently occurs with HIV disease.
The effects of HIV on the eye, since the advent of highly active antiretroviral
therapy, have been less in countries where such treatment is available but even
in such situations ophthalmic zoster can occur at higher CD4 cell counts and can 
still cause problems. Other opportunistic infections such as CMV retinitis tend
to occur at lower CD4 cell counts. However, globally treatment is not universally
available in resource poor countries where it is most needed. A major impact of
HIV in such situations is on premature mortality affecting the health care and
education workforce, which indirectly has an impact on blinding disease. In
addition, loss of family income due to illness or death of parents can affect
nutritional status of remaining family members especially children as well as the
direct effect of opportunistic infections in the eyes of those infected with HIV.

Publication Types: 
    Review

PMID: 16304581 [PubMed - indexed for MEDLINE]

601: Am J Emerg Med. 2005 Nov;23(7):899-900.

Emergent hemodialysis for acyclovir toxicity.

Hsu CC, Lai TI, Lien WC, Chen WJ, Fang CC.

Department of Emergency Medicine, National Taiwan University Hospital, and
National Taiwan University, College of Medicine, Taipei 100, Taiwan.

Publication Types: 
    Case Reports

PMID: 16291450 [PubMed - indexed for MEDLINE]

602: Arch Neurol. 2005 Nov;62(11):1774-5.

Petrositis in Ramsay Hunt syndrome with multiple cranial neuropathies.

Espay AJ, Bull RL.

Department of Neurology, University of Cincinnati, OH 45267, USA.
alberto.espay@uc.edu

Publication Types: 
    Case Reports

PMID: 16286554 [PubMed - indexed for MEDLINE]

603: AIDS. 2005 Dec 2;19(18):2183-4.

Alveolar bone necrosis and tooth exfoliation secondary to herpes zoster in the
setting of HIV/AIDS.

van Heerden WF, McEachen SE, Boy SC.

Publication Types: 
    Letter

PMID: 16284476 [PubMed - indexed for MEDLINE]

604: Blood. 2006 Mar 1;107(5):1800-5. Epub 2005 Nov 10.

Long-term acyclovir for prevention of varicella zoster virus disease after
allogeneic hematopoietic cell transplantation--a randomized double-blind
placebo-controlled study.

Boeckh M, Kim HW, Flowers ME, Meyers JD, Bowden RA.

Fred Hutchinson Cancer Research Center, Program in Infectious Diseases, 1100
Fairview Ave N, Seattle, WA 98109, USA. mboeckh@fhcrc.org

Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic
cell transplant recipients who had a history of VZV infection. A safe and
effective prevention strategy has not been established. In a double-blind
controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV
reactivation were randomized to acyclovir 800 mg twice daily or placebo given
from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was 
the primary end point; VZV disease after discontinuation of prophylaxis,
VZV-specific T-cell immunity, herpes simplex virus (HSV) infection,
cytomegalovirus (CMV) disease, survival, and safety were secondary end points.
Acyclovir significantly reduced VZV infections at 1 year after transplantation
(HR, 0.16; 95% CI, 0.035-0.74; P = .006). In the post-intervention observation
period, this difference was not statistically significant (2 years: HR, 0.52; 95%
CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically
significant difference in reconstitution of VZV-specific T-helper cell responses,
HSV infections, CMV disease, chronic graft-versus-host disease, and overall
survival between the groups. Acyclovir was well tolerated. Post-study VZV disease
predominantly occurred in patients with continued need for systemic
immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV
disease during the first year after hematopoietic cell transplantation. Periods
of prophylaxis longer than 12 months may be beneficial for those hematopoietic
cell transplant recipients on continued immune suppression.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16282339 [PubMed - indexed for MEDLINE]

605: Acta Neurol Scand. 2005 Dec;112(6):417-9.

Frequent association of multiple sclerosis with varicella and zoster.

Perez-Cesari C, Saniger MM, Sotelo J.

Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico,
Mexico City, Mexico.

BACKGROUND: A possible association of multiple sclerosis (MS) with viral diseases
has been postulated; in previous studies we have found that in Mexican mestizos
the antecedent of varicella during childhood represents a risk factor for the
development of MS during adulthood. AIM: We conducted a retrospective search for 
varicella and zoster infections associated with the development of MS. METHODS
AND RESULTS: In a cohort of 82 consecutive patients with MS we found six cases,
four of varicella and two of zoster, that were concurrent with the development or
the progress of MS. CONCLUSIONS: The association of these pathologies is higher
than expected and suggests a possible etiological relationship of the varicella
zoster virus with MS.

PMID: 16281927 [PubMed - indexed for MEDLINE]

606: MMW Fortschr Med. 2005 Oct 13;147(41):34, 36.

[Immunization in the elderly--necessary, helpful, superfluous?]

[Article in German]

Popp W.

GESUNDE LUNGE - Institut fur Atemwegs- und Lungenerkrankungen Wien.
wolfgang.popp@wienkav.at

For all adults, vaccinations against tetanus, diphtheria, poliomyelitis,
pertussis, TBE (in endemic regions) and specific vaccinations for travelers are
recommended. In addition to this standard protection, the Robert-Koch Institute
also recommends--in particular for over-60-year-olds--an annual vaccination
against influenza, as well as against pneumococci that must be repeated every six
years.

Publication Types: 
    English Abstract

PMID: 16270509 [PubMed - indexed for MEDLINE]

607: MMW Fortschr Med. 2005 Oct 13;147(41):15-6.

[Always consider complications in facial erythema]

[Article in German]

Paukstadt W.

Publication Types: 
    Case Reports
    News

PMID: 16270504 [PubMed - indexed for MEDLINE]

608: Oral Dis. 2005 Nov;11(6):370-3.

Oral lesions as indicators of HIV infection among routine dental patients in
Lagos, Nigeria.

Agbelusi GA, Wright AA.

Department of Preventive Dentistry, College of Medicine, University of Lagos,
Lagos, Nigeria. gbemisola4life2004@yahoo.com

OBJECTIVES: To document the incidental oral lesions of human immunodeficiency
virus (HIV) infection, the pattern and frequency of the lesions based on clinical
presentation and oral manifestations in routine dental patients who tested
positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral
Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, 
Nigeria between May 2002 and April 2003. During this period, all patients with
oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as
described in the EEC-WHO Classification and diagnostic criteria of oral lesions
of HIV were counseled and offered voluntary HIV testing. All the 35 patients who 
consented and tested positive were included in this study. RESULTS: Of a total of
700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen,
thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused.
Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for 
HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being
Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%),
facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An
oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients 
attending the dental clinic. Oral health care workers should practice optimal
infection control based on the Centers for Disease Control 'Standard Precautions'
guidelines on infection control for all patients to minimize occupational
transmission of HIV.

PMID: 16269028 [PubMed - indexed for MEDLINE]

609: J Eur Acad Dermatol Venereol. 2005 Nov;19(6):774-5.

Mondor's disease probably due to herpes zoster.

Yang JH, Lee UH, Jang SJ, Choi JC.

Publication Types: 
    Case Reports
    Letter

PMID: 16268897 [PubMed - indexed for MEDLINE]

610: Bull Soc Pathol Exot. 2005 Sep;98(3):187-92.

[Dermatologic manifestations associated with immune reconstitution syndrome in
HIV+ patients starting HAART: a retrospective study in French Guiana]

[Article in French]

Sarazin E, Nacher M, Toure Y, Clyti E, El Guedj M, Aznar C, Vaz T, Sainte-Marie
D, Sobesky M, Carme B, Couppie P.

Service de dermatologie, Centre hospitalier Andree-Rosemon, Avenue des
Flamboyants, 97306, Cayenne, Guyane francaise.

Immune reconstitution syndrome (IRIS) is an unusual inflammatory reaction to an
opportunistic infection in an HIV-positive patient. This syndrome occurs when
immunity is restored in the first months of an effective highly active
antiretroviral treatment (HAART). First, we described all patients with a
cutaneous form of IRIS. Then, between 1992 and 2004 we conducted a retrospective 
cohort study comparing Herpes Zoster and Herpes Simplex infections among
untreated patients, patients treated by HAART for < or = six months, and patients
treated for > six months. We observed three cases of atypical leprosy and three
original observations: two of these were fistulisation of lymph node
histoplasmosis and tuberculosis, the third one reports the recurrence of a
treated cutaneous leishmaniasis. Multivariate analysis showed that, after
controlling for age, sex and CD4 counts, patients receiving HAART for < or = six 
months were more likely to develop Herpes Zoster or herpes simplex infections (p 
< 0.005). Herpes Simplex and Herpes Zoster infections are the two most frequent
dermatological manifestations in our tropical setting. Although mycobacterial
infections are more rarely observed than in visceral IRIS, the increased
incidence of leprosy may be quite significant when the availability of HAART
spreads to developing countries.

Publication Types: 
    Case Reports
    English Abstract
    Multicenter Study

PMID: 16267958 [PubMed - indexed for MEDLINE]

611: Curr Neurol Neurosci Rep. 2005 Nov;5(6):427-8.

A vaccine to prevent herpes zoster and post-herpetic neuralgia in older adults.

Jubelt B.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 16263052 [PubMed - indexed for MEDLINE]

612: ACP J Club. 2005 Nov-Dec;143(3):61.

Comment on:
    N Engl J Med. 2005 Jun 2;352(22):2271-84.

A varicella-zoster virus vaccine reduced the burden of illness of herpes zoster
in older adults.

Fekete T.

Temple University School of Medicine, Philadelphia, Pennsylvania, USA.

Publication Types: 
    Comment

PMID: 16262218 [PubMed]

613: Med J Aust. 2005 Sep 5;183(5):278-9.

Comment on:
    Med J Aust. 2005 Sep 5;183(5):277-9.

Universal varicella vaccination. Comment.

Macartney K, Mcintyre P.

Publication Types: 
    Comment
    Letter

PMID: 16252446 [PubMed - indexed for MEDLINE]

614: FDA Consum. 2005 Jul-Aug;39(4):7.

Experimental shingles vaccine proves effective in nationwide study.

[No authors listed]

PMID: 16252393 [PubMed - indexed for MEDLINE]

615: Bone Marrow Transplant. 2006 Jan;37(1):73-80.

Herpes zoster infection in the post-hematopoietic stem cell transplant pediatric 
population may be preceded by transaminitis: an institutional experience.

Berman JN, Wang M, Berry W, Neuberg DS, Guinan EC.

Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115,
USA.

Herpes zoster (HZ), a varicella-zoster virus reactivation, frequently complicates
hematopoietic stem cell transplantation (HSCT). Its incidence, complications, and
associated risk factors in 310 children undergoing HSCT were reviewed. In all, 61
of 201(32%) patients who had undergone allogeneic and 10 of 109 (9%) patients who
had undergone autologous HSCT developed HZ. Of 90 VZV seropositive allogeneic
patients, 50 (53%) developed HZ. Seven (17%) of 41 VZV seropositive autologous
patients developed HZ. Although a substantial number of patients develop HZ in
the early post-HSCT period, risk for HZ persists and HZ can occur up to 5 years
post-HSCT. Risk factors for HZ included age >10 years (P<0.0001), allogeneic HSCT
(P<0.001), and total body irradiation (TBI) (P<0.059) in allogeneic recipients.
Of 37, 22 (59%) patients experienced an elevated alanine aminotransferase (ALT), 
unassociated with GVHD, in the month preceding HZ. Of the 48/64 patients (75%)
hospitalized for treatment (median stay, 6 days; range, 2-39), length of stay was
unaffected by donor type but increased by cutaneous dissemination and visceral
involvement (P=0.023 and 0.034, respectively) in allogeneic patients.
Consideration of HZ infection particularly in patients >10 years of age with
elevated ALT after TBI-conditioned allogeneic HSCT may permit earlier diagnosis
and therapeutic intervention.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16247423 [PubMed - indexed for MEDLINE]

616: Rev Neurol (Paris). 2005 Sep;161(8-9):836-9.

[Cerebral vasculitis secondary to Varicella-Zoster virus infection]

[Article in French]

Outteryck O, Senechal O, Berteloot D, Delalande I, Mounier-Vehier F.

Service de Neurologie, Hopital Dr Schaffner, Lens.

INTRODUCTION: Central nervous system infection by the varicella-zoster virus
(VZV) can be responsible for myelitis, meningitis, ventriculitis and large and
small-vessels encephalitis. CASE REPORT: We report the case of a 57-year-old-man 
hospitalized for deteriorating general health. Physical examination revealed
likely encephalitis associated with headache without meningeal syndrome.
Successive cerebral MRIs showed bilateral necrosis of the amygdaloid bodies and
multiple deep and sub-cortical infarcts suggestive of vasculitis. Cerebral
arteriography was normal. Three cerebral fluid examinations disclosed mononuclear
pleiocytosis with few red blood cells. PCR analysis for VZV was only positive at 
the third time. DISCUSSION: The diagnosis of VZV encephalitis is difficult
without the rash typical of zoster and because of the low sensitivity of PCR VZV 
in comparison with PCR HSV. CONCLUSION: In active viral disease, where the
prognosis depends on early treatment, we highlight the usefulness of repeated PCR
analysis and the search for antibodies in blood and cerebrospinal fluid.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16244567 [PubMed - indexed for MEDLINE]

617: J Am Acad Dermatol. 2005 Nov;53(5):890-2.

Frequent varicella zoster reactivation associated with therapeutic use of arsenic
trioxide: portents of an old scourge.

Au WY, Kwong YL.

University Department of Medicine, Queen Mary Hospital, Hong Kong.

In 44 patients treated with arsenic trioxide (As2(O3)) for acute promyelocytic
leukemia, 11 developed varicella zoster virus (VZV) reactivation (median 56 days 
[range 15-299]) after treatment. There was no preferential dermatome involvement 
or systemic spread. The actuarial risk of VZV reactivation at 1 year was 26%. No 
VZV reactivation occurred after the first year of initial treatment with As2(O3).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16243151 [PubMed - indexed for MEDLINE]

618: Ophthalmology. 2005 Dec;112(12):2184-8. Epub 2005 Oct 20.

Herpetic eye disease in diabetic patients.

Kaiserman I, Kaiserman N, Nakar S, Vinker S.

Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel.
igor@dr-kaiserman.com

PURPOSE: To study the incidence of herpetic eye disease (HED) of the ocular
surface in diabetics. DESIGN: Observational historical cohort study. SETTING: A
district of the largest health maintenance organization in Israel (the Central
District of Clalit Health Services). PARTICIPANTS: We reviewed the electronic
medical records of all patients older than 50 years (159634 patients) in the
district, and of these, 22382 (14.0%) patients had diabetes mellitus. METHODS:
All filled prescriptions for acyclovir eye ointment between January 1, 2001 and
December 31, 2003 (1483 tubes) and all hemoglobin A1c laboratory tests during
2003 (41910 tests) were documented. An ocular surface HED event was defined when 
a patient consumed at least 1 tube of topical acyclovir per month, whereas no
acyclovir use was documented 3 months before and 3 months after that event. MAIN 
OUTCOME MEASURES: Incidence of ocular surface HED events in diabetics compared
with nondiabetics adjusted for age and gender. RESULTS: After age and gender
adjustment, significantly more diabetics had ocular surface HED (5.21 per
thousand) compared with nondiabetics (4.27 per thousand; P<0.0001).
Stratification by age revealed a significantly higher prevalence of HED in
diabetics, aged 60 to 79 years. Recurrent herpetic events occurred during the
study period in 25.2% of HED-affected diabetics, and in 16.6% of HED-affected
nondiabetics (P = 0.05). Diabetics with poor glycemic control (mean annual
hemoglobin A1c > 9%) consumed significantly more ocular acyclovir (P = 0.01).
Multivariate analysis revealed this effect to be independent of age, gender,
place of birth, or place of residency. CONCLUSIONS: Ocular surface HED is
significantly more common among patients with diabetes mellitus. Poor glycemic
control correlates with increased consumption of ocular acyclovir in diabetic
patients.

PMID: 16242779 [PubMed - indexed for MEDLINE]

619: N Engl J Med. 2005 Oct 20;353(16):e14.

Images in clinical medicine. Left sixth cranial nerve palsy with herpes zoster
ophthalmicus.

Jude E, Chakraborty A.

Tameside General Hospital, Ashton-under-Lyne OL6 9RW, United Kingdom.

Publication Types: 
    Case Reports

PMID: 16236731 [PubMed - indexed for MEDLINE]

620: Int J Clin Pract. 2005 Nov;59(11):1326-33.

Comment in:
    Int J Clin Pract. 2005 Nov;59(11):1248-50.

Is Europe ready to embrace a policy of universal varicella vaccination?

Ramet J, Weil-Olivier C, Sedlak W; Confederation of the European Specialists of
Paediatrics (CESP)/European Academy of Paediatrics (EAP) CESP/EAP.

Universiteit Antwerpen, UZA and Paola Kinderziekenhuis ZNA, Antwerp, Belgium.
jose.ramet@zna.be

For the first time, a live attenuated varicella vaccine with an indication for
universal vaccination is licensed in all EU countries. It is now time to consider
whether in Europe there should be widespread vaccination against varicella to
prevent this common and highly infectious disease. Increasing numbers of
countries are adopting vaccination programmes against the disease. In those
countries where a routine vaccination policy has been adopted, the success of the
vaccine has been significant. The USA, which prior to the launch of a universal
vaccination programme in 1995 had 4 million cases of varicella per year, has seen
a dramatic reduction in varicella morbidity and mortality rates. A universal
varicella vaccination policy is an option that needs to be considered for Europe 
not only in medical terms but also because it would be socially and economically 
appropriate.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16236088 [PubMed - indexed for MEDLINE]

621: Drugs Today (Barc). 2005 Aug;41(8):509-16.

Pregabalin: a new agent for the treatment of neuropathic pain.

Zareba G.

Department of Environmental Medicine, University of Rochester, School of Medicine
and Dentistry, Rochester, New York 14642, USA. grazyna_zareba@urmc.rochester.edu

Pregabalin (Lyrica, Pfizer) is a GABA analog with similar structure and actions
to gabapentin. It has antiepileptic, analgesic and anxiolytic activity.
Pregabalin is indicated for the management of neuropathic pain associated with
diabetic neuropathy and post-herpetic neuralgia. Peak plasma levels occur
approximately 1 hour after oral doses and oral bioavailability is about 90%.
Based on AUC data, food does not significantly affect the extent of absorption.
Pregabalin is not protein-bound and exhibits a plasma half-life of about 6 hours,
which is not dose-dependent. Hepatic metabolism is negligible, and most of the
oral dose (95%) appears unchanged in the urine. Pregabalin is a safe and
well-tolerated new treatment for neuropathic pain. Furthermore, pregabalin has
proven efficacy in adjunctive therapy of refractory partial seizures and in the
treatment of acute pain, generalized anxiety disorder and social phobia.

Publication Types: 
    Review

PMID: 16234874 [PubMed - indexed for MEDLINE]

622: J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1604-5.

Conduction block in the forearm associated with acute varicella zoster virus
infection.

Raasch US, Heath JP.

Publication Types: 
    Case Reports
    Letter

PMID: 16227564 [PubMed - indexed for MEDLINE]

623: Clin Neurol Neurosurg. 2006 Dec;108(8):772-4. Epub 2005 Oct 13.

An extremely unusual presentation of varicella zoster viral infection of cranial 
nerves mimicking Garcin syndrome.

Nishioka K, Fujishima K, Kobayashi H, Mizuno Y, Okuma Y.

Department of Neurology, Juntendo University Shizuoka Hospital, 1129 Nagaoka,
Inzunokuni, Shizuoka 410-2295, Japan.

We report a patient with the varicella zoster viral (VZV) infection of multiple
cranial nerves mimicking Garcin syndrome, who initially presented with Ramsay
Hunt syndrome (herpes zoster oticus). A 78-year-old man showed left facial palsy 
with zosteric eruptions in his left auricle and dysphagia, followed by left total
ophthalmoplegia. His serum anti-VZV antibody titer was elevated. Cerebrospinal
fluid examination revealed pleocytosis with a slightly elevated protein level. He
was treated with intravenous acyclovir and corticosteroids. His tongue weakness
resolved, and then ocular movement improved. The improvement of facial palsy and 
swallowing difficulty was delayed. VZV infection should be considered even in
patients who show unilateral multiple cranial neuropathy mimicking Garcin
syndrome because it is treatable.

Publication Types: 
    Case Reports

PMID: 16226370 [PubMed - indexed for MEDLINE]

624: Br J Dermatol. 2005 Nov;153(5):981-6.

The role of CD4 and CD8 cytotoxic T lymphocytes in the formation of viral
vesicles.

Morizane S, Suzuki D, Tsuji K, Oono T, Iwatsuki K.

Department of Dermatology, Okayama University Graduate School of Medicine and
Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
gmd14058@cc.okayama-u.ac.jp

BACKGROUND: Herpetic vesicles caused by herpes simplex virus and varicella zoster
virus, and hydroa vacciniforme (HV) are characterized by umbilicated vesicule
formation. OBJECTIVES: To understand the histogenesis of umbilicated vesicles in 
herpetic vesicles and HV, we demonstrated the presence of the virus-associated
molecules in the lesions, and the pathogenic role of cytotoxic T-lymphocyte (CTL)
immune responses. METHODS: Phenotyping of infiltrating cells was carried out in
biopsy specimens from herpes simplex, varicella, herpes zoster and HV, and
compared with nonviral contact dermatitis. Viral antigens and Epstein-Barr
virus-encoded small nuclear RNA (EBER) were detected by immunostaining and by in 
situ hybridization, respectively. Infiltrating CTLs expressing granzyme B and
granulysin were determined by double immunostaining using confocal laser scanning
microscopy. RESULTS: In all herpetic vesicles, the corresponding viral antigens
were observed in the cytopathic keratinocytes, and infiltration of lymphoid cells
was present in the upper dermis and around the vessels. In all HV lesions
studied, EBER+ T cells made up 5-10% of the dermal infiltrates and the dermal
infiltrates contained almost no CD56 cells. CTLs expressing granzyme B and
granulysin were present in both herpetic and HV lesions, in which they made up
10-30% of the total dermal infiltrates, whereas they comprised less than 5% of
the infiltrates of biopsy specimens from nonviral contact dermatitis. Confocal
laser microscopic examination demonstrated that both CD4+ and CD8+ T cells
expressed granzyme B and granulysin. CONCLUSIONS: CD4+ and/or CD8+ CTLs reactive 
to the virus-infected cells might be responsible for the histogenesis of herpetic
and HV lesions characterized by umbilicated vesicles.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16225610 [PubMed - indexed for MEDLINE]

625: Expert Rev Vaccines. 2005 Oct;4(5):629-43.

Review of the Varilrix varicella vaccine.

Chiu SS, Lau YL.

Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The
University of Hong Kong, Hong Kong SAR, China. ssschiu@hkucc.hku.hk

Varicella zoster virus causes an acute infection that affects most children
globally, but the age of infection can be greater in residents of tropical areas.
It has generally been considered a mild disease, although there are accumulating 
data to show that it can cause significant morbidity and mortality in
immunocompetent as well as immunocompromised children and adults. Oka-strain live
attenuated varicella vaccines were developed in the 1970s. Varilrix developed by 
GlaxoSmithKline Biologicals (Rixensart, Belgium), is one of the vaccines produced
and marketed in over 80 countries. Similar to the other Oka-strain vaccines,
Varilrix is safe, immunogenic and efficacious in both immunocompromised and
immunocompetent children and adults.

Publication Types: 
    Comparative Study
    Review

PMID: 16221065 [PubMed - indexed for MEDLINE]

626: Hong Kong Med J. 2005 Oct;11(5):399-402.

Herpetic shoulder paresis in a Chinese elderly patient.

Tam TC, Chan KY, Ho SL, Luk JK, Chu LW.

Acute Geriatrics Unit, Grantham Hospital, Wong Chuk Hang, Hong Kong.

A patient with left shoulder girdle weakness secondary to herpetic myotomal
paresis is reported. Needle electromyography revealed denervational discharge
from the left supraspinatus, deltoid, and brachioradialis muscles, compatible
with a radiculopathy that was relevant to his myotomes affected by zoster
infection. The patient was managed with range-of-movement and strengthening
exercises as well as pain relief for post-herpetic neuralgia. Further studies are
required to determine whether antiviral treatment can limit the extent of motor
deficit and hasten recovery. Zoster paresis should be one of the differential
diagnoses of girdle muscle weakness.

Publication Types: 
    Case Reports

PMID: 16219961 [PubMed - indexed for MEDLINE]

627: Otolaryngol Head Neck Surg. 2005 Oct;133(4):647.

Laryngeal zoster mimicking a laryngeal cancer.

Higuchi E, Nakamaru Y, Ohwatari R, Sakashita T, Mesuda Y, Homma A, Furuta Y,
Fukuda S.

Publication Types: 
    Case Reports

PMID: 16213968 [PubMed - indexed for MEDLINE]

628: Pain. 2005 Nov;118(1-2):97-111. Epub 2005 Oct 5.

Varicella zoster virus induces neuropathic changes in rat dorsal root ganglia and
behavioral reflex sensitisation that is attenuated by gabapentin or sodium
channel blocking drugs.

Garry EM, Delaney A, Anderson HA, Sirinathsinghji EC, Clapp RH, Martin WJ,
Kinchington PR, Krah DL, Abbadie C, Fleetwood-Walker SM.

Division of Veterinary Biomedical Sciences, Centre for Neuroscience Research,
University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK.

Reactivation of latent varicella zoster virus (VZV) within sensory trigeminal and
dorsal root ganglia (DRG) neurons produces shingles (zoster), often accompanied
by a chronic neuropathic pain state, post-herpetic neuralgia (PHN). PHN persists 
despite latency of the virus within human sensory ganglia and is often
unresponsive to current analgesic or antiviral agents. To study the basis of
varicella zoster-induced pain, we have utilised a recently developed model of
chronic VZV infection in rodents. Immunohistochemical analysis of DRG following
VZV infection showed the presence of a viral immediate early gene protein (IE62) 
co-expressed with markers of A- (neurofilament-200; NF-200) and C- (peripherin)
afferent sensory neurons. There was increased expression of neuropeptide Y (NPY) 
in neurons co-expressing NF-200. In addition, there was an increased expression
of alpha2delta1 calcium channel, Na(v)1.3 and Na(v)1.8 sodium channels, the
neuropeptide galanin and the nerve injury marker, Activating Transcription
Factor-3 (ATF-3) as determined by Western blotting in DRG of VZV-infected rats.
VZV infection induced increased behavioral reflex responsiveness to both noxious 
thermal and mechanical stimuli ipsilateral to injection (lasting up to 10 weeks
post-infection) that is mediated by spinal NMDA receptors. These changes were
reversed by systemic administration of gabapentin or the sodium channel blockers,
mexiletine and lamotrigine, but not by the non-steroidal anti-inflammatory agent,
diclofenac. This is the first time that the profile of VZV infection-induced
phenotypic changes in DRG has been shown in rodents and reveals that this profile
appears to be broadly similar (but not identical) to changes in other neuropathic
pain models.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16213091 [PubMed - indexed for MEDLINE]

629: Int J STD AIDS. 2005 Oct;16(10):673-6.

Herpes zoster in HIV-1-infected patients in the era of highly active
antiretroviral therapy: a prospective observational study.

Hung CC, Hsiao CF, Wang JL, Chen MY, Hsieh SM, Sheng WH, Chang SC.

Department of Internal Medicine, National Taiwan University Hospital and National
Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan.
hcc0401@ha.mc.ntu.edu.tw

Between June 1994 and May 2003, 93 of 716 (13.0%) HIV-infected patients with a
median baseline cell differentiation CD4+ count of 61 x 10(6) cells/L (range,
1-1206 x 10(6) cells/L) developed 103 episodes of herpes zoster [HZ], with an
incidence of 5.67 per 100 person-years (PY). The incidence of HZ in the
pre-highly active antiretroviral therapy (HAART) era (17.21 per 100 PY) was
significantly higher than that in the post-HAART era (5.05 per 100 PY) (P <
0.0001). In the first six months of enrollment, the incidence of HZ was
significantly higher than that between six and 12 months both in the pre-HAART
(27.65 per 100 PY versus 8.43 per 100 PY, P = 0.02) and post-HAART era (17.79 per
100 PY versus 3.39 per 100 PY, P < 0.0001). In multivariate analyses, only
baseline CD4+ count remained a significant risk factor associated with HZ. HZ did
not increase mortality rate either in the pre-HAART or post-HAART era, although
the risk for HIV progression was significantly higher in patients with HZ
(adjusted odds ratio [OR], 1.747, 95% confidence interval, 1.037-2.943). We
conclude that the incidence of HZ was highest in the first six months of
enrollment in patients at late stage of HIV infection, which did not increase
with the introduction of HAART. Baseline CD4+ lymphocyte count was the most
significant risk factor associated with development of HZ. HZ was associated with
increased risk for HIV progression, but not mortality.

PMID: 16212714 [PubMed - indexed for MEDLINE]

630: Herpes. 2005 Oct;12(2):33-7.

Comment in:
    Herpes. 2005 Oct;12(2):32.

Analysis of the cost-effectiveness of varicella vaccine programmes based on an
observational survey in the Latium region of Italy.

Gialloreti LE, Divizia M, Pica F, Volpi A.

Department of Public Health, University of Rome Tor Vergata, Via Montpellier 1,
00133 Rome, Italy.

Varicella is the most widespread childhood disease in Italy. However, as in many 
parts of the world, the country does not yet have a unified approach to the
management of the disease. A cost-effectiveness analysis of varicella vaccination
strategies, using the Latium region in Italy as a case study, was undertaken.
Mass vaccination is only recommended if the immunization programme can achieve
coverage of over 85% in a short time. However, experience in Italy with
non-compulsory vaccinations has shown this is difficult to achieve. Consequently,
eradication of the disease is not seen as an attainable short-term goal. For mass
varicella vaccination to be successful, it must be run at a national as well as
regional level in combination with education programmes, and a reliable
surveillance system. The interaction between varicella and herpes zoster must
also be taken into account when considering vaccination strategies, as zoster
vaccination strategies may have an impact on varicella coverage.

PMID: 16209858 [PubMed - indexed for MEDLINE]

631: Herpes. 2005 Oct;12(2):32.

Comment on:
    Herpes. 2005 Oct;12(2):33-7.

Selective versus universal vaccination for varicella zoster virus infection: what
holds the key to successful disease control?

Schleiss M.

Publication Types: 
    Comment
    Editorial

PMID: 16209857 [PubMed - indexed for MEDLINE]

632: Health News. 2005 Sep;11(9):5-6.

Shingles vaccine found effective; could offer relief to millions. Zoster vaccine 
could be available as early as next year to prevent this painful skin and nerve
condition.

[No authors listed]

PMID: 16208806 [PubMed - indexed for MEDLINE]

633: Harv Womens Health Watch. 2005 Aug;12(12):5.

Shingles vaccine shows promise in large trial.

[No authors listed]

Publication Types: 
    News

PMID: 16208771 [PubMed - indexed for MEDLINE]

634: Harv Health Lett. 2005 Aug;30(10):4-5.

These shots aren't just kid stuff. Adults may soon be rolling up their sleeves to
get vaccinated for shingles and whooping cough.

[No authors listed]

PMID: 16206387 [PubMed - indexed for MEDLINE]

635: Ann Intern Med. 2005 Oct 4;143(7):539-41.

The growing paradigm of preventing disease: vaccines to prevent herpes zoster and
pertussis in adults.

Poland GA.

Publication Types: 
    Editorial

PMID: 16204167 [PubMed - indexed for MEDLINE]

636: Environ Health Perspect. 2005 Oct;113(10):1373-5.

Case report: occupationally related recurrent varicella (chickenpox) in a
hospital nurse.

Ku CH, Liu YT, Christiani DC.

School of Public Health, National Defense Medical Center, National Defense
University, Taipei, Taiwan.

Commonly accepted outcomes of varicella-zoster virus (VZV) infections include
chickenpox (primary) and shingles (recurrence or latency), as well lifetime
immunity against chickenpox. We report the case of a registered nurse who worked 
in a neurologic surgery ward in a general hospital in Taipei, Taiwan. While
working there for approximately 1 year, she developed recurrent chickenpox after 
caring for a paraparesis patient, who had herpes zoster during hospitalization in
August 2002. The varicella incubation period was 10 days, which matched the range
(10-21 days). Recently negative specific serum IgM and positive specific serum
IgG indicated a past VZV infection. The nurse did not get herpes zoster from the 
second episode of varicella on 9 August 2002 to 4 April 2005 and is now
convalescing. We conclude that occupational VZV hazards exist in the health care 
environment and suggest testing for VZV antibody and a VZV vaccination program
for susceptible health care workers. Key words: chickenpox, indirect fluroscent
antibody, occupational exposure, polymerase chain reaction, shingles, Taiwan,
varicella-zoster virus.

Publication Types: 
    Case Reports

PMID: 16203249 [PubMed - indexed for MEDLINE]

637: Br J Hosp Med (Lond). 2005 Sep;66(9):542-3.

Unusual presentation of Ramsay-Hunt syndrome without-facial nerve palsy.

Leong SC, Karkanevatos A.

Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool L7
8XP.

Publication Types: 
    Case Reports

PMID: 16200803 [PubMed - indexed for MEDLINE]

638: Clin Exp Dermatol. 2005 Nov;30(6):643-5.

Coexistence of psoriasis and linear IgA disease in a patient with recent herpes
zoster infection.

Cooke N, Jenkinson H, Wojnarowska F, McKenna K, Alderdice J.

Department of Dermatology, Royal Victoria Hospital, UK. nicolacooke36@hotmail.com

We report the case of a 29-year-old man with chronic plaque psoriasis who
developed linear IgA disease following herpes zoster infection. There has only
been one previous report describing the coexistence of psoriasis and linear IgA
disease, which was confirmed by immunopathological studies. In our patient,
immunoblotting studies identified IgA antibodies binding to BP180 and BP230
antigens, and IgG autoantibodies binding weakly to the BP180 antigen. This is an 
interesting case that we believe is an example of epitope spreading in the
development of autoimmune subepidermal bullous diseases.

Publication Types: 
    Case Reports

PMID: 16197377 [PubMed - indexed for MEDLINE]

639: N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5.

Comment on:
    N Engl J Med. 2005 Jun 2;352(22):2271-84.

A vaccine to prevent herpes zoster.

Carroll I, Gaeta R, Mackey S.

Publication Types: 
    Comment
    Letter

PMID: 16196123 [PubMed - indexed for MEDLINE]

640: N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5.

Comment on:
    N Engl J Med. 2005 Jun 2;352(22):2271-84.    N Engl J Med. 2005 Jun 2;352(22):2344-6.

A vaccine to prevent herpes zoster.

Kessler KM.

Publication Types: 
    Comment
    Letter

PMID: 16192493 [PubMed - indexed for MEDLINE]

641: Am Fam Physician. 2005 Sep 15;72(6):1082.

Information from your family doctor. Shingles: easing the pain.

American Academy of Family Physicians.

Publication Types: 
    Patient Education Handout

PMID: 16190506 [PubMed - indexed for MEDLINE]

642: Am Fam Physician. 2005 Sep 15;72(6):1075-80.

Comment in:
    Am Fam Physician. 2006 Aug 1;74(3):378; author reply 381.

Herpes zoster and postherpetic neuralgia: prevention and management.

Mounsey AL, Matthew LG, Slawson DC.

Department of Family Medicine, University of Virginia, Charlottesville, Virginia 
22908, USA.

The recognizable appearance and the dermatomal distribution of herpes zoster
lesions usually enable a clinical diagnosis to be made easily. Herpes zoster and 
postherpetic neuralgia occur mainly in older patients. The role of the varicella 
vaccine in preventing herpes zoster is uncertain, but is being studied. There is 
evidence to support using antiviral therapy and possibly low-dose tricyclic
antidepressants to prevent postherpetic neuralgia. There is good evidence that
treating herpes zoster with antiviral medication is beneficial, particularly in
patients older than 50 years with severe outbreaks. The use of steroids has an
unfavorable risk-benefit ratio. In patients who develop postherpetic neuralgia,
there is good evidence to support treatment with gabapentin and tricyclic
antidepressants. More evidence for treatment with capsaicin cream, lidocaine
patch, and opioids is needed. Intrathecal methylprednisolone is an option for
patients with persistent pain.

PMID: 16190505 [PubMed - indexed for MEDLINE]

643: J Fam Pract. 2005 Sep;54(9):757.

Herpes zoster vaccine safe and effective for older adults.

[No authors listed]

PMID: 16189893 [PubMed]

644: J Virol. 2005 Oct;79(20):13070-81.

Dissection of a novel nuclear localization signal in open reading frame 29 of
varicella-zoster virus.

Stallings CL, Silverstein S.

Integrated Program in Cellular, Molecular and Biophysical Studies and the
Department of Microbiology, Columbia University, College of Physicians and
Surgeons, New York, New York 10032, USA.

Open reading frame 29 (ORF29) of varicella-zoster virus (VZV) encodes a 120-kDa
single-stranded DNA binding protein (ORF29p) that is not packaged in the virion
and is expressed during latency. During lytic infection, ORF29p is localized
primarily to infected cell nuclei. In contrast, ORF29p is found exclusively in
the cytoplasm in neurons of the dorsal root ganglia obtained at autopsy from
seropositive latently infected patients. ORF29p accumulates in the nuclei of
neurons in dorsal root ganglia obtained at autopsy from patients with active
zoster. The localization of this protein is, therefore, tightly correlated with
the proposed VZV lytic/latent switch. In this report, we have investigated the
nuclear import mechanism of ORF29p. We identified a novel nuclear targeting
domain bounded by amino acids 9 to 154 of ORF29p that functions independent of
other VZV-encoded factors. In vitro import assays in digitonin-permeabilized HeLa
cells reveal that ORF29p is transported into the nucleus by a Ran-, karyopherin
alpha- and beta-dependent mechanism. These data are further supported by the
demonstration that a glutathione S-transferase-karyopherin alpha fusion interacts
with ORF29p, but not with a protein containing a point mutation in its nuclear
localization signal (NLS). Therefore, the region of ORF29p responsible for its
nuclear targeting is also involved in the association with karyopherin alpha. As 
a result of this interaction, this noncanonical NLS appears to hijack the
classical cellular nuclear import machinery. Elucidation of the mechanisms
governing ORF29p nuclear targeting could shed light on the VZV reactivation
process.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16189009 [PubMed - indexed for MEDLINE]

645: J Virol. 2005 Oct;79(20):12921-33.

T-cell tropism and the role of ORF66 protein in pathogenesis of varicella-zoster 
virus infection.

Schaap A, Fortin JF, Sommer M, Zerboni L, Stamatis S, Ku CC, Nolan GP, Arvin AM.

Department of Pediatrics, Stanford University School of Medicine, CA 94305-5208, 
USA. aschaap@stanford.edu

The pathogenesis of varicella-zoster virus (VZV) involves a cell-associated
viremia during which infectious virus is carried from sites of respiratory
mucosal inoculation to the skin. We now demonstrate that VZV infection of T cells
is associated with robust virion production and modulation of the apoptosis and
interferon pathways within these cells. The VZV serine/threonine protein kinase
encoded by ORF66 is essential for the efficient replication of VZV in T cells.
Preventing ORF66 protein expression by stop codon insertion (pOka66S) impaired
the growth of the parent Oka (pOka) strain in T cells in SCID-hu T-cell
xenografts in vivo and reduced formation of VZV virions. The lack of ORF66
protein also increased the susceptibility of infected T cells to apoptosis and
reduced the capacity of the virus to interfere with induction of the interferon
(IFN) signaling pathway following exposure to IFN-gamma. However, preventing
ORF66 protein expression only slightly reduced growth in melanoma cells in
culture and did not diminish virion formation in these cells. The pOka66S virus
showed only a slight defect in growth in SCID-hu skin implants compared with
intact pOka. These observations suggest that the ORF66 kinase plays a unique role
during infection of T cells and supports VZV T-cell tropism by contributing to
immune evasion and enhancing survival of infected T cells.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16188994 [PubMed - indexed for MEDLINE]

646: J Virol. 2005 Oct;79(20):12658-66.

Varicella-zoster virus activates inflammatory cytokines in human monocytes and
macrophages via Toll-like receptor 2.

Wang JP, Kurt-Jones EA, Shin OS, Manchak MD, Levin MJ, Finberg RW.

Department of Medicine, University of Massachusetts Medical Center, Worcester,
01605, USA. jennifer.wang@umassmed.edu

The pattern recognition receptor Toll-like receptor 2 (TLR2) has been implicated 
in the response to several human viruses, including herpes simplex viruses (types
1 and 2) and cytomegalovirus. We demonstrated that varicella-zoster virus (VZV)
activates inflammatory cytokine responses via TLR2. VZV specifically induced
interleukin-6 (IL-6) in human monocytes via TLR2-dependent activation of
NF-kappaB, and small interfering RNA designed to suppress TLR2 mRNA reduced the
IL-6 response to VZV in human monocyte-derived macrophages. Unlike other
herpesviruses, the cytokine response to VZV was species specific. VZV did not
induce cytokines in murine embryonic fibroblasts or in a mouse cell line,
although VZV did activate NF-kappaB in a human cell line expressing a murine TLR2
construct. Together, these results suggest that TLR2 may play a role in the
inflammatory response to VZV infection.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16188968 [PubMed - indexed for MEDLINE]

647: J Acquir Immune Defic Syndr. 2005 Oct 1;40(2):169-74.

The incidence of, risk factors for, and sequelae of herpes zoster among HIV
patients in the highly active antiretroviral therapy era.

Gebo KA, Kalyani R, Moore RD, Polydefkis MJ.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore,
MD 21287, USA. kgebo@jhmi.edu

BACKGROUND: Whereas the incidence, risk factors, and clinical sequelae of herpes 
zoster have been studied in the general population and in HIV patients in the era
before highly active antiretroviral therapy (HAART), they have yet to be fully
understood in the current era of HAART. METHODS: We conducted a retrospective
cohort study of patients enrolled in an urban HIV clinic between January 1, 1997 
and December 31, 2001. Patients with an episode of herpes zoster during this
period were identified, and their charts were reviewed. A nested case-control
analysis was used to assess factors associated with an initial episode of herpes 
zoster. Multivariate conditional logistic regression analyses were used to assess
risk factors for zoster. Logistic regression was performed to assess factors
associated with complicated zoster. RESULTS: Two hundred eighty-two episodes of
herpes zoster were identified in 239 patients. Of these episodes, 158 were new
occurrences of zoster and 124 were recurrent zoster events. The incidence of
zoster during the study period was 3.2 per 100 person-years of follow-up. The
incident cases reflected the clinic population, with most patients being male
(63%) and African American (77%) and having injection drug use as their HIV risk 
factor (49%). The mean age of the patients was 41 years. Sixty-seven percent of
patients had single dermatomal involvement, and the thorax was involved in 41%.
In multivariate regression, being on HAART (odds ratio [OR] = 2.39, 95%
confidence interval [CI]: 1.65 to 3.49) and a CD4 count of 50 to 200 cells/mm (OR
= 2.69, 95% CI: 1.44 to 5.01) compared with a CD4 count less than 50 cells/mm
were associated with an increased risk of zoster. Twenty-eight patients (18%)
developed post-herpetic neuralgia (PHN), and 29 patients (18%) had other
complications. Male-to-male sex as an HIV risk factor (P = 0.02) and being on
HAART at a zoster episode (P = 0.03) were protective against complicated zoster. 
CONCLUSIONS: Our results suggest that zoster infection rates have not changed in 
the current HAART era but that a significant percentage of patients develop
complications, particularly PHN, which is quite remarkable considering the young 
age of our population.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16186734 [PubMed - indexed for MEDLINE]

648: J Gen Virol. 2005 Oct;86(Pt 10):2673-84.

Transcriptomal analysis of varicella-zoster virus infection using long
oligonucleotide-based microarrays.

Kennedy PG, Grinfeld E, Craigon M, Vierlinger K, Roy D, Forster T, Ghazal P.

Glasgow University Department of Neurology, Southern General Hospital, Institute 
of Neurological Sciences, Glasgow G51 4TF, UK. P.G.Kennedy@clinmed.gla.ac.uk

Varicella-zoster virus (VZV) is a human herpes virus that causes varicella as a
primary infection and herpes zoster following reactivation of the virus from a
latent state in trigeminal and spinal ganglia. In order to study the global
pattern of VZV gene transcription, VZV microarrays using 75-base oligomers to 71 
VZV open reading frames (ORFs) were designed and validated. The
long-oligonucleotide approach maximizes the stringency of detection and polarity 
of gene expression. To optimize sensitivity, microarrays were hybridized to
target RNA and the extent of hybridization measured using resonance light
scattering. Microarray data were normalized to a subset of invariant ranked
host-encoded positive-control genes and the data subjected to robust formal
statistical analysis. The programme of viral gene expression was determined for
VZV (Dumas strain)-infected MeWo cells and SVG cells (an immortalized human
astrocyte cell line) 72 h post-infection. Marked quantitative and qualitative
differences in the viral transcriptome were observed between the two different
cell types using the Dumas laboratory-adapted strain. Oligonucleotide-based VZV
arrays have considerable promise as a valuable tool in the analysis of viral gene
transcription during both lytic and latent infections, and the observed
heterogeneity in the global pattern of viral gene transcription may also have
diagnostic potential.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16186220 [PubMed - indexed for MEDLINE]

649: Health News. 2005 Aug;11(8):2.

Shingles vaccine proves highly effective.

[No authors listed]

Publication Types: 
    News

PMID: 16184636 [PubMed - indexed for MEDLINE]

650: Hua Xi Kou Qiang Yi Xue Za Zhi. 2005 Aug;23(4):338-40.

[Investigation on oral lesions in 64 Chinese HIV/AIDS patients in Guangxi
province]

[Article in Chinese]

Tao RC, Deng HJ, Ya ZK, Guo SZ, Liang SX, Liu W.

Dept. of Oral Medicine, Affiliated Stomatology Hospital of Guangxi Medical
University, Nanning 530021, China.

OBJECTIVE: To investigate the prevalence, age and gender distribution and
clinical features of HIV/AIDS oral lesions in patients in Guangxi province, and
to provide the epidemiological information for prevention and treatment of these 
diseases in the certain population. METHODS: A total of 64 HIV/AIDS patients were
included in this study. All patients HIV serum-status was confirmed in Guangxi
Center of Disease Control (GXCDC). Oral examination was carried out by
standardized specialists. HIV/AIDS orofacial lesions were recorded and diagnosed 
using the EC Clearing House Criteria on Oral Problems related to HIV Infection
(1992). RESULTS: Among the total of 64 HIV/AIDS patients included in this study, 
there were 53 males and 11 females, with mean age of 36.1 years. Candidiasis was 
the most common lesion with the pseudomembranous type predominating. High
prevalences of xerostomia, 11 oral ulceration and 7 HIV related periodontitis
were noted. 6 Herpetic stomatitis and 3 herpes zoster, 2 oral hairy leukoplakia
and 1 Kaposi's sarcoma and 1 lymphadentitis also were found. CONCLUSION: This
study shows a high prevalence of candidiasis, salivary gland disease. Maybe oral 
ulceration prevalence is not increased, but lesion severity is increased with
more severe heperiform or major RAU. It suggested that HIV/AIDS usually shows
oral lesion and partly can appear in early phase.

Publication Types: 
    English Abstract
    Research Support, Non-U.S. Gov't

PMID: 16178201 [PubMed - in process]

651: Rev Med Virol. 2005 Nov-Dec;15(6):393-406.

Herpes simplex virus and varicella-zoster virus: why do these human
alphaherpesviruses behave so differently from one another?

Mori I, Nishiyama Y.

Department of Microbiology and Immunology, Aichi Medical University School of
Medicine, Nagakute, Aichi 480-1195, Japan. isamor@aichi-med-u.ac.jp

Members of the Herpesviridae family of viruses are classified into the alpha,
beta and gamma subfamilies. The alpha subfamily is estimated to have diverged
from the beta and gamma subfamilies 200-220 million years ago. The ancestors of
the herpes simplex virus (HSV) and the varicella-zoster virus (VZV), two
ubiquitous and clinically important human pathogens, appeared 70-80 million years
ago. As these viruses coevolved with their specific primate hosts, genetic
rearrangements led to the development of the contemporary alphaherpesviruses and 
their distinct complement of genes. Here the distinct features of HSV and VZV are
discussed in terms of their transmissibility, clinical picture, tissue tropism,
establishment of latency/reactivation and immune evasion, which can, at least in 
part, be explained by differences in their genomes.

Publication Types: 
    Comparative Study
    Review

PMID: 16173110 [PubMed - indexed for MEDLINE]

652: J Eur Acad Dermatol Venereol. 2005 Sep;19(5):593-6.

Zosteriform cutaneous metastases from breast adenocarcinoma.

Bassioukas K, Nakuci M, Dimou S, Kanellopoulou M, Alexis I.

Department of Skin and Veneral Diseases, Medical School, University of Ioannina, 
Greece. konabass@cc.uoi.gr

Cutaneous metastases from breast adenocarcinoma are usually nodular, single or
multiple. Their zosteriform distribution is very rare. We present a 54-year-old
woman with cutaneous zosteriform nodular metastases on the right side of her
thorax, and infiltration of the corresponding arm, 3 months after the excision of
adenocarcinoma of her right breast.

Publication Types: 
    Case Reports

PMID: 16164715 [PubMed - indexed for MEDLINE]

653: Neurologia. 2005 Sep;20(7):374-6.

[Brachial plexitis and myelitis and herpes-zoster lumbar plexus disorder in
patient treated with infliximab]

[Article in Spanish]

Arias M, Arias-Rivas S, Dapena D, Mera A.

Servicio de Neurologia, Complejo Hospitalario Universitario de Santiago de
Compostela, La Coruna. mariasg@meditex.es

Infliximab, a chimeric monoclonal antibody, is a TNF-a inhibitor approved for use
in refractory rheumatoid arthritis and Crohn s disease. We present the case of a 
patient affected by severe rheumatoid arthritis who was successfully treated with
infliximab. She suffered diverse neurological complications: brachial plexitis,
asymptomatic thoracic myelitis with extensive lesions in MRI study, and herpes
zoster lumbar plexitis. We review the neurological adverse effects of infliximab 
(aseptic meningitis, opportunistic germs infections, disseminated herpes zoster) 
and focus in their potential adverse effect to induce central and peripheral
nervous system demyelination.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16163582 [PubMed - indexed for MEDLINE]

654: Zhong Xi Yi Jie He Xue Bao. 2005 Sep;3(5):400-1.

[Clinical observation on treatment of herpes zoster with collateral-pricking and 
healthy energy strengthening therapy]

[Article in Chinese]

Yu F, Xu SW, Zhang W.

Department of Acupuncture-Moxibustion, First People's Hospital, Shanghai Jiao
Tong University, Shanghai 200080, China.

PMID: 16159579 [PubMed - indexed for MEDLINE]

655: J Med Assoc Thai. 2005 May;88(5):678-81.

Herpes zoster, clinical course and associated diseases: A 5-year retrospective
study at Tamathibodi Hospital.

Tunsuriyawong S, Puavilai S.

Department of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Rd,
Bangkok 10400, Thailand.

OBJECTIVE: Herpes zoster was more frequently found in immunocompromised hosts and
elderly persons than in general population. The aim of this study is to find out 
the distributions of skin lesions, treatments, complications of herpes zoster and
associated diseases that occur in concomitant with or after herpes zoster
infections. MATERIAL AND METHOD: The medical records of the patients diagnosed as
herpes zoster between January 1995 - December 2000 were reviewed. Only the
patients who were followed up regularly at Ramathibodi hospital for at least 3
years after the first diagnosis of herpes zoster were enrolled into the study.
Demographic data, distribution of skin lesions, treatments, complications of
herpes zoster and associated diseases were recorded. RESULTS: Three hundred and
ninety-nine cases were enrolled in the study. Three hundred and ninety-eight
patients (99.7%) had one dermatomal involvement. Sixty-seven patients (16.8%) had
postherpetic neuralgia. Fifty-six patients had associated HIV infection. In 3
years followed up, 17 patients developed HIV infection, 3 patients developed
acute leukemia, 2 patients developed mycosis fungoides.

PMID: 16149688 [PubMed - indexed for MEDLINE]

656: Am J Dermatopathol. 2005 Oct;27(5):411-7.

Varicella-zoster-virus folliculitis promoted clonal cutaneous lymphoid
hyperplasia.

Aram G, Rohwedder A, Nazeer T, Shoss R, Fisher A, Carlson JA.

Department of Pathology, Albany Medical College, Albany, New York 12208, USA.

Post herpes zoster (HZ) reactions have been associated with panoply of
neoplastic, inflammatory, and fibro-inflammatory cutaneous disorders. Varicella
zoster virus (VZV) DNA has not been identified in most of these reports. After an
episode of HZ, a healthy, active 90-year-old female developed ulcerative nodules 
in the affected trigeminal V1 dermatome and the contra-lateral trigeminal region 
over a 1-year period. Excision and/or biopsy of all these lesions showed similar 
pathologic changes that consisted of herpetic folliculitis, adjacent dense mixed 
nodular lymphocytic infiltrates with germinal centers (cutaneous lymphoid
hyperplasia (CLH)), and in the deeper excision specimens, an obliterative
vasculitis of a vessel with smooth muscle in its wall. Immunophenotype analysis
revealed a mixed, predominate T- and B-cell population without loss of pan-T cell
antigens or aberrant expression by B cells of T-cell antigens. Polymerase chain
reaction for herpetic DNA was positive for VZV DNA. Lymphocyte gene rearrangement
analysis revealed 2 distinct, anatomically and chronologically, monoclonal B-cell
populations and a monoclonal T-cell population in one nodule. Treatment with
valacyclovir has lead to almost complete resolution of her cutaneous nodules
after 6 months of therapy. In this case, it can be surmised that persistence of
VZV infection and lack of effective cell-mediated immunity lead to development of
both immunopathology (vasculitis) and excessive lymphoid cell proliferation
(CLH).

Publication Types: 
    Case Reports

PMID: 16148411 [PubMed - indexed for MEDLINE]

657: Med J Aust. 2005 Sep 5;183(5):277-9.

Comment in:
    Med J Aust. 2005 Sep 5;183(5):278-9.

Universal varicella vaccination.

Mackenzie GA.

Publication Types: 
    Letter

PMID: 16138807 [PubMed - indexed for MEDLINE]

658: Pediatr Nephrol. 2005 Dec;20(12):1750-5. Epub 2005 Aug 24.

Infection in children with lupus nephritis receiving pulse and oral
cyclophosphamide therapy.

Opastirakul S, Chartapisak W.

Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, 
Chiang Mai University, Thailand. sopastir@mail.med.cmu.ac.th

Infection is the major complication of cyclophosphamide therapy in patients with 
lupus nephritis. The objectives of this study were to report and compare the rate
of infection between children with lupus nephritis who had received intravenous
pulse cyclophosphamide (IVCY) and those who had received oral cyclophosphamide
(OCY) and to determine the risk factors for infection during treatment with
cyclophosphamide in these groups. Records of nine patients who had received IVCY 
from the beginning [pure intravenous cyclophosphamide (PIVCY) group], 11 patients
who had received prior oral cyclophosphamide and later switched to IVCY [combined
intravenous cyclophosphamide (CIVCY) group] and 41 patients who had received OCY 
were reviewed. Infection occurred in 21 of 61 patients (34%). In the PIVCY group,
four episodes of infection occurred in three of nine patients (33%). In the CIVCY
group, six episodes of infection occurred in four of 11 patients (36%). In the
OCY group, 18 episodes of infection occurred in 14 of 41 patients (34%). The rate
of infection between these groups was not different (P=0.99). None of the
following parameters were risk factors for infection: cumulative dose of
cyclophosphamide, leukopenia and neutropenia. On the contrary, white blood cell
(WBC) count and polymorphonuclear cell (PMN) count were significantly less in the
no-infection group (P=<0.001, P<0.001, respectively), with odds ratios for
leukopenia (WBCs <4,000 mm(3)) and neutropenia (PMNs <1,500 mm(3)) between the
infection and the no-infection group equal to 0.18 (95%CI 0.05-0.63) and 0 (95%CI
0-0.19), respectively. Most of the patients who had infection received
prednisolone at a dosage of more than 0.5 mg/kg per day (67% of the PIVCY group, 
50% of the CIVCY group and 83% of the OCY group). Fatal infections occurred in
two patients who had concomitant active systemic lupus erythematosus (SLE).
Although lymphopenia (lymphocyte count <1,500/mm(3)) was not the risk factor for 
infection, it was observed that six of seven patients with herpes zoster had
lymphopenia. Herpes zoster seemed to occur more frequently in the OCY group (15%)
than in the whole IVCY group (5%), but there was no statistical difference
(P=0.41). We conclude that the rate of infection in the IVCY and OCY group was
not different. Infection is likely to occur in patients receiving a concomitant
high dose of prednisolone. The occurrence of fatal infection in patients with
active disease should be noted. No single risk factor was detected in this study.

Publication Types: 
    Comparative Study

PMID: 16133037 [PubMed - indexed for MEDLINE]

659: Int J Toxicol. 2005 Jul-Aug;24(4):205-13.

Universal varicella vaccination: efficacy trends and effect on herpes zoster.

Goldman GS.

Medical Veritas International (MVI), Pearblossom, California 93553, USA.
pearblossominc@aol.com

In 1995, the Varicella Active Surveillance Project (VASP) was established in
Antelope Valley (California), a geographically distinct high-desert community of 
300,000 residents, as one of three sites in the nation in a cooperative agreement
with the Centers for Disease Control and Prevention (CDC) to collect baseline
demographic and clinical data and to monitor trends in varicella (chickenpox)
following introduction of varicella vaccine. Herpes zoster (shingles) was added
to the active surveillance January 1, 2000. The universal varicella program has
proven effective in terms of reducing the number of reported verified varicella
cases by 85%, from 2,934 in 1995 to 412 in 2002. Prior to this dramatic
reduction, immunologic boosting due to exogenous exposures to wild-type
varicella-zoster virus (VZV) in the community (1) caused mean serum anti-VZV
levels among vaccines to increase with time after vaccination and (2) served as a
mechanism that helped suppress the reactivation of herpes zoster (HZ), especially
among individuals with a previous history of wild-type varicella.That immunologic
boosting might play a significant role in both varicella and the closely related 
HZ epidemiology is evidenced by (1) a decline in vaccine efficacy by over 20%,
from 95.7% (95% C.I., 82.7% to 98.9%) in 1999 to 73.9% (95% C.I., 57.9% to 83.8%)
in 2001 and (2) an unexpectedly high cumulative (2000 to 2003) true incidence
rate of 223 (95% C.I. 180-273) per 100,000 person-years (p-y) among children <10 
years old with a previous history of varicella. Because capture-recapture methods
demonstrate a likely lower bound of 50% underreporting, the actual rate is likely
double or 446 per 100,000 p-y, approaching the HZ rate reported among older
adults. Other recent studies based on VASP data have mitigated against discovery 
of the above trends that challenge several initial assumptions inherent to the
universal varicella program, namely, (1) a single dose confers long-term immunity
and (2) there is no immunologically mediated link between varicella and HZ
incidence. As vaccinated children replace those with a prior history of wild-type
varicella in the <10 age group, increasing HZ incidence among this cohort will be
of less concern in the near future. However, previous scientific studies,
including the present preliminary results from active surveillance indicate that 
HZ may be increasing among adults. It may be difficult to design booster
interventions that are cost-effective and meet or exceed the level of protection 
provided by immunologic boosting that existed naturally in the community in the
prelicensure era.

PMID: 16126614 [PubMed - indexed for MEDLINE]

660: Ophthalmologica. 2005 Sep-Oct;219(5):272-5.

Ocular findings in Japanese patients with varicella-zoster virus infection.

Yoshida M, Hayasaka S, Yamada T, Yanagisawa S, Hayasaka Y, Nakamura N, Mihara M.

Department of Ophthalmology, Toyama Medical and Pharmaceutical University,
Toyama, Japan. ophthal@ms.toyama-mpu.ac.jp

PURPOSE: To examine ocular findings in Japanese patients with varicella, herpes
zoster ophthalmicus, and acute retinal necrosis. METHODS: A retrospective study
was conducted. Information on the ocular, cutaneous, systemic, and virologic
findings on pediatric and adult patients was obtained from medical records.
RESULTS: A total of 77 (45 male and 32 female) patients were enrolled in the
study: 4 children had varicella, 68 adults had herpes zoster ophthalmicus, and 5 
adults had acute retinal necrosis. Children with varicella had eruptions on the
eyelid. Patients with herpes zoster ophthalmicus had eruptions, conjunctivitis,
keratitis, iridocyclitis, and other findings. Patients with acute retinal
necrosis had intracameral cells and retinal lesions. Some patients with herpes
zoster ophthalmicus had malignancy, type 2 diabetes mellitus, or other disease.
One pregnant woman developed acute retinal necrosis shortly after varicella
infection. A total of 48% of patients with negative Hutchinson sign had ocular
lesions, while all patients with positive sign showed ocular lesions. Patients
with varicella and herpes zoster ophthalmicus had good visual acuity at the last 
visit. Some patients with acute retinal necrosis had poor visual acuity at the
last visit. CONCLUSIONS: Patients with varicella, herpes zoster ophthalmicus, and
acute retinal necrosis had several ocular complications. Some patients with acute
retinal necrosis had poor visual outcomes. Ophthalmologists should be aware that 
acute retinal necrosis may develop shortly after varicella infection. Copyright
2005 S. Karger AG, Basel.

PMID: 16123552 [PubMed - indexed for MEDLINE]

661: Clin J Oncol Nurs. 2005 Aug;9(4):443-6.

Herpes zoster: medical and nursing management.

Sandy MC.

msandy@kumc.edu

Herpes zoster, the latent descendent of the varicella zoster virus, commonly is
seen in clinical practice. Healthcare providers must recognize and treat the
virus to decrease the incidence of postherpetic neuralgic pain syndrome.
Treatment with an antiviral medication regimen should be initiated rapidly for
patients who have had lesions for up to 72 hours. Acyclovir has been the
treatment of choice for herpes zoster in the past, but newer drugs, such as
valacyclovir, a prodrug of acyclovir, and famciclovir, are as effective for
treating the virus and have more convenient dosing regimens and decreased
incidence of postherpetic neuralgia.

Publication Types: 
    Review

PMID: 16117211 [PubMed - indexed for MEDLINE]

662: J Cutan Pathol. 2005 Sep;32(8):581-4.

'Specific' cutaneous infiltrate of B-cell chronic lymphocytic leukemia at the
site of a florid herpes simplex infection.

Ziemer M, Bornkessel A, Hahnfeld S, Weyers W.

Department of Dermatology, Friedrich-Schiller-University of Jena, Freiburg,
Germany. mirjana.ziemer@derma.uni-jena.de

Background: Specific cutaneous infiltrates in patients with leukemia generally
carry a grim prognosis. However, non-neoplastic skin diseases may be associated
with recruitment of normal and neoplastic leukocytes circulating in the
peripheral blood. In those instances, neoplastic cells may be detected in skin
lesions without an adverse effect on prognosis. Methods: In a patient with B-cell
chronic lymphocytic leukemia, a specific infiltrate developed at the site of a
florid herpes simplex infection. Clinically, the lesion presented itself as an
ulcerated tumor. Results: Histopathologically, the lesion was characterized by a 
dense, diffuse infiltrate of small hyperchromatic lymphocytes throughout the
entire dermis. Lymphocytes showed an aberrant CD20(+)/CD43(+)/CD5(+) phenotype of
neoplastic B cells, and monoclonal rearrangement of immunoglobulin gamma genes
could be demonstrated by polymerase chain reaction. Although criteria for
leukemia cutis were fulfilled, the patient did well. Conclusions: The cutaneous
infiltrate of neoplastic cells seemed to be part of a physiologic response to the
antigenic stimulus, rather than indicating an exacerbation of leukemia. Ziemer M,
Bornkessel A, Hahnfeld S, Weyers W. 'Specific' cutaneous infiltrate of B-cell
chronic lymphocytic leukemia at the site of a florid herpes simplex infection.

Publication Types: 
    Case Reports

PMID: 16115059 [PubMed - indexed for MEDLINE]

663: Rev Saude Publica. 2005 Aug;39(4):687-90. Epub 2005 Aug 16.

[Varicella outbreak in childcare centers and schools of the of 22nd Regional
Health Division, June 2005]

[Article in Portuguese]

EPISUS-SES/SP.

Publication Types: 
    Technical Report

PMID: 16113924 [PubMed - indexed for MEDLINE]

664: Nippon Rinsho. 2005 Jul;63 Suppl 7:294-6.

[Diagnostic tests: Varicella-zoster virus]

[Article in Japanese]

Yamashita T.

Department of Dermatology, Sapporo Medical University, School of Medicine.

Publication Types: 
    Review

PMID: 16111254 [PubMed - indexed for MEDLINE]

665: J Neurol Neurosurg Psychiatry. 2005 Sep;76(9):1308-9.

Erratum in:
    J Neurol Neurosurg Psychiatry. 2005 Dec;76(12):1747. Mahad, D [corrected to
Mahad, DJ].

Aciclovir induced posterior leucoencephalopathy.

Mahad DJ, Hellden A, Jarvis J, Mitra D, Gholkar A, Chinnery PF.

Publication Types: 
    Case Reports
    Letter

PMID: 16107379 [PubMed - indexed for MEDLINE]

666: Rev Iberoam Micol. 2005 Jun;22(2):125-6.

[Clinical cases in medical mycology. Case No. 16]

[Article in Spanish]

Negroni R, Tuculet MA.

Unidad de Micologia, Hospital de Infecciosas Francisco Javier Muniz, Uspallata
2272 1282, Buenos Aires, Argentina. hmmicologia@intramed.net

Publication Types: 
    Case Reports

PMID: 16107174 [PubMed - indexed for MEDLINE]

667: Rev Neurol (Paris). 2005 May;161(5):590-2.

[Complete ophthalmoplegia complicating ophthalmic herpes zoster]

[Article in French]

Papeix C, Dumurgier J, Milea D, Pierrot DC.

Service de Neurologie 1, Hopital de la Pitie-Salpetriere (AP-HP), Paris.
caroline.papeix@psl.ap-hop-paris.fr

We report a case of a 73-year-old patient with complete ophthalmoplegia following
an episode of ophthalmic herpes zoster. MRI showed an associated ipsilateral
temporal meningioma with cavernous sinus extension. We discuss the possible
responsibility of these two conditions in the ocular motor signs.

Publication Types: 
    Case Reports
    English Abstract

PMID: 16106813 [PubMed - indexed for MEDLINE]

668: Eur J Haematol. 2005 Sep;75(3):234-40.

Effect of varicella zoster virus infection on bone marrow function.

Al-Anazi KA, Al-Jasser AM, Evans DA.

Section of Adult Haematology and Bone Marrow Transplant, King Faisal Cancer
Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi
Arabia. khalid_alanazi@yahoo.com

BACKGROUND: Most viral infections are known to exert adverse effects on bone
marrow function. However, certain viruses have recently been found to be
therapeutically beneficial in the treatment of some malignant disorders. METHODS 
AND MATERIALS: A retrospective study was conducted at the Armed Forces Hospital, 
Riyadh, Saudi Arabia. The changes in the hematological parameters following
varicella-zoster virus (VZV) infection in patients with a variety of
hematological disorders were compared with those in a control group having the
same spectrum of disorders and treated in the same unit over the same period of
time but never had VZV infection. Both groups of patients received the same
treatment protocols for their primary hematological disorders. Definitive
treatment (DT) such as chemotherapy alone, anti-thymocyte globulin or bone marrow
transplant was also employed in the management of patients belonging to both
groups. RESULTS: White blood cell counts, platelet counts and hemoglobin
concentrations in the study group started to increase 40 d after chickenpox or
herpes zoster infection and these increases lasted for periods as long as 1050 d.
The changes in platelet counts were more pronounced than those in other
hematological parameters. There was a significant difference (P < 0.0001) between
the two groups of patients in the values of platelet counts achieved between 280 
and 1050 d after DT (mean platelet count: 262 x 10(9)/L in the study group vs.
180 x 10(9)/L in the control group, median: 288.17 x 10(9)/L in the study group
vs. 180 x 10(9)/L in the control group, range: 102 to 415 x 10(9)/L in the study 
group vs. 26 to 365 x 10(9)/L in the control group of patients). Compared to the 
control group, the study group of patients achieved their maximum blood counts
much earlier after DT. The maximum leucocytic count was achieved at a mean
duration of 269.21 d in the study group and 349.61 d in the control group. The
maximum hemoglobin level was achieved at a mean duration of 319.5 d in the study 
group and 402.6 d in the control group. The maximum platelet count was achieved
at a mean duration of 271.4 d in the study group and 318.9 d in the control group
of patients. CONCLUSION: VZV may behave differently from other members of the
herpes group of viruses e.g. human cytomegalovirus and Epstein-Barr virus. Our
observations suggest that VZV infection causes stimulation of bone marrow
activity. Copyright Blackwell Munksgaard 2005.

PMID: 16104880 [PubMed - indexed for MEDLINE]

669: J Virol. 2005 Sep;79(17):11501-6.

Replication of varicella-zoster virus in human skin organ culture.

Taylor SL, Moffat JF.

Department of Microbiology and Immunology, SUNY Upstate Medical University,
Syracuse, NY 13210, USA.

Varicella-zoster virus (VZV) infection is restricted to humans, which hinders
studies of its pathogenesis in rodent models of disease. To facilitate the study 
of VZV skin tropism, we developed an ex vivo system using human fetal skin organ 
culture (SOC). VZV replication was analyzed by plaque assay, transmission
electron microscopy, and histology. The yield of infectious VZV from SOC
increased approximately 100-fold over 6 days, virions were abundant, and lesions 
developed that contained VZV antigens and resembled varicella and zoster lesions.
The SOC system for VZV replication has applications for testing virus mutants and
antiviral drugs.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16103201 [PubMed - indexed for MEDLINE]

670: Pain. 2005 Sep;117(1-2):154-61.

Tactile allodynia in patients with postherpetic neuralgia: lack of change in skin
blood flow upon dynamic stimulation.

Besson M, Brook P, Chizh BA, Pickering AE.

Pain Clinic, Bristol Royal Infirmary, Bristol BS2 8HW, UK.

Tactile allodynia is a common, troublesome feature of neuropathic pain. Allodynia
has been proposed to involve abnormal Abeta-afferent coupling in the dorsal horn 
resulting in C-fibre activation and increased skin blood flow (SBF). Thus,
changes in SBF could provide an objective measure of allodynia. We searched for
this mechanism in patients with postherpetic neuralgia (PHN) with varying degrees
of cutaneous sensory loss. We mapped the allodynic area in PHN patients using
cotton buds and von Frey hairs. Quantitative thermal testing was performed to
assess small fibre function in the affected and mirror-image areas. At a
subsequent visit the area of allodynia was remapped. Then the SBF in the affected
and control areas was quantified before and after allodynic stimulation using
laser Doppler imaging and subsequent single point continuous monitoring to detect
rapid changes. We enrolled 10 PHN patients (medians: age 77 yrs, duration 20
months, ongoing pain 5). The allodynic area (range 11-546 cm2) was stable across 
the sessions. Thermal testing showed similar (n=5) or reduced (n=5) warmth and
pain sensation in the affected versus control area. Following allodynic
stimulation (median evoked pain-5) we saw no changes in SBF using either imaging 
(repeated measures ANOVA, P=0.73) or single point monitoring. This was the case
for all patients regardless of the degree of sensory impairment in the affected
dermatome. In conclusion, in a representative population of PHN patients we found
no evidence of changes in SBF in response to allodynic stimulation. Hence, SBF
measurements are not suitable for assessing allodynia.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16098664 [PubMed - indexed for MEDLINE]

671: Expert Rev Mol Med. 2005 Aug 10;7(15):1-24.

Molecular and therapeutic aspects of varicella-zoster virus infection.

Quinlivan M, Breuer J.

Skin Virus Laboratory, Institute of Cell and Molecular Science, 4 Newark Street, 
Whitechapel, London, E1 28E, UK. m_quinlivan@hotmail.com

Varicella-zoster virus (VZV) is a highly species-specific member of the
Herpesviridae family. The virus exhibits multiple cell tropisms, infecting
peripheral blood mononuclear cells and skin cells before establishing latency in 
sensory neurons. Such tropisms are essential both for primary infection, which
manifests itself as chickenpox (varicella), and subsequent reactivation to cause 
herpes zoster (shingles). The highly cell-associated nature of the virus, coupled
with its narrow host range, has resulted in the lack of an animal model that
mimics its diseases in humans, thereby greatly hindering the study of events in
VZV pathogenesis. Despite this, extensive studies both in vitro and in vivo in
small-animal models have provided a fascinating insight into molecular events
that govern VZV diseases. In addition, VZV has become the first human herpes
virus for which a live attenuated vaccine has been developed.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16098235 [PubMed - indexed for MEDLINE]

672: J Ky Med Assoc. 2005 Jul;103(7):303-6.

Case report on motor neuropathy associated with herpes zoster.

Murphy P.

University of Louisville, Department of Family and Geriatric Medicine, KY 40202, 
USA. pjmurph01@gwise.louisville.edu

BACKGROUND: Complications associated with herpes zoster are primarily sensory,
but motor involvement, especially in late life, can be part of the symptom
complex. CASE REPORT: We report a case of herpes zoster with motor neuropathy in 
a 66-year-old female. Eighteen months after diagnosis and treatment, the patient 
is regaining muscular strength in the affected limb. DISCUSSION: Treatment of
motor neuropathy mainly consists of physical and occupational therapy. Most
patients achieve functional recovery.

Publication Types: 
    Case Reports

PMID: 16095260 [PubMed - indexed for MEDLINE]

673: Emerg Med Australas. 2005 Aug;17(4):330-40.

Evidence-based emergency medicine at the 'coal face'.

Than M, Bidwell S, Davison C, Phibbs R, Walker M.

Clinical Decision Support Unit and Centre for Evidence-Based Health Care,
Christchurch, New Zealand. martin.than@cdhb.govt.nz

While evidence-based medicine may be trumpeted by zealots, managers and
politicians, incorporating it into clinical practice is easier said than done.
The present article aims to show that it can be achieved and gives some clinical 
examples to illustrate this. An appendix contains a summary of useful databases
and websites for accessing good medical information and evidence, quickly and
reliably near the bedside.

Publication Types: 
    Case Reports

PMID: 16091095 [PubMed - indexed for MEDLINE]

674: Neurology. 2005 Aug 9;65(3):444-7.

Comment in:
    Neurology. 2005 Aug 9;65(3):349-50.

A single dose of gabapentin reduces acute pain and allodynia in patients with
herpes zoster.

Berry JD, Petersen KL.

UCSF Pain Clinical Research Center, Department of Neurology, University of
California, San Francisco, CA, USA.

This randomized, double-blind, placebo-controlled crossover study measured the
effect of a single dose of oral gabapentin (900 mg) on pain and allodynia
associated with herpes zoster. Pain severity decreased by 66% with gabapentin
compared to 33% with placebo. Reductions in allodynia area and severity, and
overall pain relief, were also greater with gabapentin.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16087911 [PubMed - indexed for MEDLINE]

675: Neurology. 2005 Aug 9;65(3):349-50.

Comment on:
    Neurology. 2005 Aug 9;65(3):444-7.

Herpes zoster and the prevention of postherpetic neuralgia: beyond antiviral
therapy.

Tenser RB, Dworkin RH.

Publication Types: 
    Comment
    Editorial

PMID: 16087894 [PubMed - indexed for MEDLINE]

676: Biochem Biophys Res Commun. 2005 Sep 23;335(2):505-11.

dsRNA-mediated innate immunity of epidermal keratinocytes.

Tohyama M, Dai X, Sayama K, Yamasaki K, Shirakata Y, Hanakawa Y, Tokumaru S,
Yahata Y, Yang L, Nagai H, Takashima A, Hashimoto K.

Department of Dermatology, Ehime University School of Medicine, Shitsukawa,
Toon-city, Ehime 791-0295, Japan.

MIP-1alpha, a CC chemokine, recruits monocytes, natural killer cells,
lymphocytes, and neutrophils, and plays a critical role in viral infection.
Since, the lesional epidermis of herpes zoster expressed MIP-1alpha, we
hypothesized that keratinocytes produce MIP-1alpha in response to
virus-associated dsRNA via TLR3. To investigate this, we examined cultured human 
keratinocytes for MIP-1alpha production induced by poly(I:C), a TLR3 ligand.
Poly(I:C) treatment induced MIP-1alpha production, interestingly,
poly(I:C)-induced IFN-alpha and -beta production preceded MIP-1alpha production. 
A neutralizing antibody for IFN-beta significantly inhibited the
poly(I:C)-induced MIP-1alpha production indicating that MIP-1alpha production is 
via IFN-beta. IFN-alpha priming enhanced TLR3 expression and MIP-1alpha
production in poly(I:C)-treated keratinocytes. This suggests that IFN-alpha
enhanced the TLR3 expression and reinforced the response of keratinocytes to
poly(I:C), which resulted in an increase in MIP-1alpha production. In conclusion,
normal human keratinocytes produce MIP-1alpha in response to dsRNA via TLR3, and 
this production is regulated by IFN-alpha/beta.

PMID: 16087162 [PubMed - indexed for MEDLINE]

677: Clin Perinatol. 2005 Sep;32(3):671-96.

Human herpes viruses in pregnancy: cytomegalovirus, Epstein-Barr virus, and
varicella zoster virus.

Hollier LM, Grissom H.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of
Texas Houston Medical School, Lyndon B. Johnson General Hospital, 5656 Kelley
Street, Houston, TX 77026, USA. lisa.m.hollier@uth.tmc.edu

Viruses of the human herpesvirus family can have profound effects on pregnancy.
Primary maternal infection with cytomegalovirus (CMV) and varicella during
pregnancy has been associated with fetal abnormalities and neonatal disease.
Public awareness of the role of cytomegalovirus in the etiology of developmental 
disorders and chronic disabilities needs to increase. With time, we may see new
interventions for treatment of infected pregnant women and prevention of
long-term effects. Attention must be focused on development of a safe and
effective vaccine. With the introduction of an efficacious varicella vaccine, the
rate of varicella in pregnancy is expected to decrease dramatically. Physicians
caring for women have the opportunity to prevent the complications of varicella
by identifying and vaccinating susceptible women.

Publication Types: 
    Review

PMID: 16085026 [PubMed - indexed for MEDLINE]

678: CMAJ. 2005 Aug 2;173(3):249.

Vaccination boosts adult immunity to varicella zoster virus.

Weir E.

PMID: 16076818 [PubMed - indexed for MEDLINE]

679: Acta Anaesthesiol Taiwan. 2005 Jun;43(2):73-7.

Starting dose of gabapentin for patients with post-herpetic neuralgia--a
dose-response study.

Jean WH, Wu CC, Mok MS, Sun WZ.

Department Anaesthesiology, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC.

BACKGROUND: Gabapentin has been shown to provide pain relief for post-herpetic
neuralgia at dosage of 1200 to 2400 mg/day. However, the initial dosing strategy 
has not been thoroughly investigated. The purpose of this study was to establish 
the initial dosing strategy in the treatment of the gabapentin-naive patients
with post-herpetic neuralgia. METHODS: This clinical study was an open-label,
randomized, time-sequence and controlled trial. Each gabapentin-naive subject was
allocated to receive either 200 mg (100 mg, twice daily), 400 mg (100 mg, four
times daily), or 600 mg (200 mg, three times daily) of gabapentin for three days.
The analgesic effect and occurrence of dizziness, drowsiness, and fatigue were
assessed at day 0 and day 3. RESULTS: A total of 61 subjects (32 male/29 female) 
were enrolled in this study. The intensity of pain was greatly improved in all
three groups after three days of treatment (visual analog scale decreased from
6.5 +/- 1.6 to 4.5 +/- 2.1, P < 0.05). There was no statistically significant
difference among subjects taking 200 mg, 400 mg, or 600 mg with respect to
dizziness, drowsiness or fatigue. CONCLUSIONS: This study shows that elderly
gabapentin-naive subjects no matter whether receiving 200, 400 or 600 mg/day of
gabapentin benefited a moderate pain relief with minimal side effects at the
first three days of treatment. Since starting with a minimal dose of 200 mg/day
did not offer a better reduction of side effects, we suggest that 600 mg/day
gabapentin could be a safe and effective starting dose for patients with
post-herpetic neuralgia.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 16060401 [PubMed - indexed for MEDLINE]

680: Br J Oral Maxillofac Surg. 2007 Jan;45(1):71-3. Epub 2005 Jul 28.

Herpes zoster associated with tooth resorption and periapical lesions.

Ramchandani PL, Mellor TK.

Department of Oral and Maxillofacial Surgery, Poole General Hospital, Longfleet
Road, Poole, Dorset, UK. parkashr@msn.com

A 72-year-old woman presented with multiple periapical lesions and resorption of 
teeth in a single quadrant 17 years after an attack of herpes zoster (shingles)
of the maxillary division of the trigeminal nerve. It is possible that cases of
tooth resorption that were previously classified as idiopathic may have a viral
aetiology and we suggest that these patients should be asked about a previous
attack of shingles.

Publication Types: 
    Case Reports

PMID: 16054735 [PubMed - indexed for MEDLINE]

681: J Gen Intern Med. 2005 Aug;20(8):748-53.

The incidence of herpes zoster in a United States administrative database.

Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA.

Department of Health Economic Statistics, Merck Research Laboratories, Blue Bell,
PA, USA. ralph_insinga@merck.com

BACKGROUND: Few recent studies have reported data on the incidence of herpes
zoster (HZ) in U.S. general clinical practice. OBJECTIVE: To estimate the age-
and sex-specific incidence of HZ among U.S. health plan enrollees. DESIGN: Data
for the years 2000 to 2001 were obtained from the Medstat MarketScan database,
containing health insurance enrollment and claims data from over 4 million U.S.
individuals. Incident HZ cases were identified through HZ diagnosis codes on
health care claims. The burden of HZ among high-risk individuals with recent care
for cancer, HIV, or transplantation was examined in sub-analyses. Overall
incidence rates were age- and sex-adjusted to the 2000 U.S. population.
PARTICIPANTS: MarketScan U.S. health plan enrollees of all ages. MEASUREMENTS AND
MAIN RESULTS: We identified 9,152 incident cases of HZ (3.2 per 1,000
person-years) (95% confidence interval [CI], 3.1 to 3.2 per 1,000). Annual HZ
rates per 1,000 person-years were higher among females (3.8) than males (2.6)
(P<.0001). HZ rates rose sharply with age, and were highest among individuals
over age 80 (10.9 per 1,000 person-years) (95% CI, 10.2 to 11.6). The incidence
of HZ per 1,000 person-years among patients with evidence of recent care for
transplantation, HIV infection, or cancer (10.3) was greater than for individuals
without recent care for these conditions (3.0) (P<.0001). CONCLUSIONS: The
overall incidence of HZ reported in the present study was found to be similar to 
rates observed in U.S. analyses conducted 10 to 20 years earlier, after age- and 
sex-standardizing estimates from all studies to the 2000 U.S. population. The
higher rate of HZ in females compared with males contrasts with prior U.S.
studies.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16050886 [PubMed - indexed for MEDLINE]

682: Clin Neurophysiol. 2005 Sep;116(9):2051-7.

Diagnostic relevance of transcranial magnetic and electric stimulation of the
facial nerve in the management of facial palsy.

Nowak DA, Linder S, Topka H.

Department of Psychiatry III, University of Ulm, Germany. dr.dennis.nowak@gmx.de

OBJECTIVE: Earlier investigations have suggested that isolated conduction block
of the facial nerve to transcranial magnetic stimulation early in the disorder
represents a very sensitive and potentially specific finding in Bell's palsy
differentiating the disease from other etiologies. METHODS: Stimulation of the
facial nerve was performed electrically at the stylomastoid foramen and
magnetically at the labyrinthine segment of the Fallopian channel within 3 days
from symptom onset in 65 patients with Bell's palsy, five patients with Zoster
oticus, one patient with neuroborreliosis and one patient with nuclear facial
nerve palsy due to multiple sclerosis. RESULTS: Absence or decreased amplitudes
of muscle responses to early transcranial magnetic stimulation was not specific
for Bell's palsy, but also evident in all cases of Zoster oticus and in the case 
of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more
markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to
a more severe degree of axonal degeneration. The degree of amplitude reduction of
the muscle response to electrical stimulation reliably correlated with the
severity of facial palsy. CONCLUSIONS: Transcranial magnetic stimulation in the
early diagnosis of Bell's palsy is less specific than previously thought. While
not specific with respect to the etiology of facial palsy, transcranial magnetic 
stimulation seems capable of localizing the site of lesion within the Fallopian
channel. SIGNIFICANCE: Combined with transcranial magnetic stimulation, early
electrical stimulation of the facial nerve at the stylomastoid foramen may help
to establish correct diagnosis and prognosis.

Publication Types: 
    Clinical Trial

PMID: 16024292 [PubMed - indexed for MEDLINE]

683: Med Clin (Barc). 2005 Jul 9;125(6):215-20.

[Treatment and prevention in herpes zoster]

[Article in Spanish]

Garcia A, Guerra-Tapia A, Torregrosa JV.

Hospital Universitario La Princesa, Madrid, Spain.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16022835 [PubMed - indexed for MEDLINE]

684: BMJ. 2005 Jul 16;331(7509):147-51.

Managing ophthalmic herpes zoster in primary care.

Opstelten W, Zaal MJ.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Netherlands. W.Opstelten@umcutrecht.nl

Publication Types: 
    Review

PMID: 16020856 [PubMed - indexed for MEDLINE]

685: PLoS Med. 2005 Jul;2(7):e164. Epub 2005 Jul 26.

Analgesic therapy in postherpetic neuralgia: a quantitative systematic review.

Hempenstall K, Nurmikko TJ, Johnson RW, A'Hern RP, Rice AS.

Royal Hampshire County Hospital, Winchester, United Kingdom.

BACKGROUND: Postherpetic neuralgia (PHN) is a complication of acute herpes
zoster, which is emerging as a preferred clinical trial model for chronic
neuropathic pain. Although there are published meta-analyses of analgesic therapy
in PHN, and neuropathic pain in general, the evidence base has been substantially
enhanced by the recent publication of several major trials. Therefore, we have
conducted a systematic review and meta-analysis for both efficacy and adverse
events of analgesic therapy for PHN. METHODS AND FINDINGS: We systematically
searched databases (MEDLINE 1966-2004, EMBASE 1988-2004, CINAHL 1982-2002, and
PubMed [29 October 2004]) for trials of PHN. We also searched references of
retrieved studies and review articles for further trials. We included trials that
examined adult patients with PHN of greater duration than 3 mo, that were
blinded, randomised, and had at least one measure of pain outcome. Dichotomous
pain outcome data were extracted for 50% decrease in baseline pain using a
hierarchy of pain/pain-relief measurement tools. Where available, dichotomous
data were also collected for adverse events. Calculated estimates of efficacy
included relative benefit and number needed to treat. Of 62 studies identified,
35 were randomised controlled trials. Of these, 31 were placebo controlled and
suitable for meta-analysis, from which it was possible to extract dichotomous
efficacy outcome data from 25. This meta-analysis revealed that there is evidence
to support the use of the following orally administered therapies: tricyclic
antidepressants, "strong" opioids, gabapentin, tramadol, and pregabalin. Topical 
therapies associated with efficacy were lidocaine 5% patch and capsaicin.
Finally, a single study of spinal intrathecal administration of lidocaine and
methyl prednisolone demonstrated efficacy, although this has yet to be
replicated. Data suggest that the following therapies are not associated with
efficacy in PHN: certain NMDA receptor antagonists (e.g., oral memantine, oral
dextromethorphan, intravenous ketamine), codeine, ibuprofen, lorazepam, certain
5HT1 receptor agonists, and acyclovir. Topical administration of benzydamine,
diclofenac/diethyl ether, and vincristine (iontophoresis) are similarly not
associated with efficacy, nor are intrathecal administration of lidocaine alone
or epidural administration of lidocaine and methylprednisolone, intravenous
therapy with lidocaine, subcutaneous injection of Cronassial, or acupuncture.
However, many of the trials that demonstrated a lack of efficacy represented
comparatively low numbers of patient episodes or were single-dose studies, so it 
may be appropriate to regard such interventions as "not yet adequately tested"
rather than demonstrating "no evidence of efficacy." Topical aspirin/diethyl
ether has not been adequately tested. CONCLUSION: The evidence base supports the 
oral use of tricyclic antidepressants, certain opioids, and gabapentinoids in
PHN. Topical therapy with lidocaine patches and capsaicin is similarly supported.
Intrathecal administration of methylprednisolone appears to be associated with
high efficacy, but its safety requires further evaluation.

Publication Types: 
    Review

PMID: 16013891 [PubMed - indexed for MEDLINE]

686: Neurology. 2005 Jul 12;65(1):170.

Delayed oculomotor nerve palsy after bilateral cervical zoster in an
immunocompetent patient.

Karmon Y, Gadoth N.

Department of Neurology, Meir General Hospital, Kfar Saba 44281, Israel.

Publication Types: 
    Case Reports

PMID: 16009918 [PubMed - indexed for MEDLINE]

687: Clin Transplant. 2005 Aug;19(4):566-70.

Fatal varicella zoster virus encephalitis in two patients following allogeneic
hematopoietic stem cell transplantation.

Hackanson B, Zeiser R, Bley TA, Pantazis G, Huzly D, Bertz H, Finke J.

Department of Hematology/Oncology, Freiburg University Medical Center, Freiburg, 
Germany. hackanson@mm11.ukl.uni-freiburg.de

BACKGROUND: Reduced cellular immunocompetence following allogeneic hematopoietic 
stem cell transplantation (aHSCT) increases susceptibility to viral infections.
Varicella zoster virus (VZV) reactivation in this setting most commonly manifests
as dermatomal herpes zoster but in some cases life-threatening VZV encephalitis
occurs. STUDY DESIGN/RESULTS: We describe the cases of two patients who presented
with shingles 3 and 18 months, respectively, after HLA-matched peripheral blood
stem cell transplantation (PBSCT). Unfortunately, in the further clinical course 
both patients developed fatal VZV encephalitis, despite initial high-dose
intravenous therapy with acyclovir and in one case with additional
VZV-immunoglobulin. CONCLUSION: These two cases suggest that rapid intervention
with systemic treatment is warranted and raise the question whether initial
combination therapy with intravenous acyclovir and foscarnet, VZV vaccination or 
long-term low-dose acyclovir are needed to improve treatment and clinical outcome
in immunocompromised patients, having undergone allogeneic HSCT.

Publication Types: 
    Case Reports

PMID: 16008607 [PubMed - indexed for MEDLINE]

688: Fam Pract. 2005 Oct;22(5):523-8. Epub 2005 Jul 8.

Do herpes zoster patients receive antivirals? A Dutch National Survey in General 
Practice.

Opstelten W, van Essen GA, Moons KG, van Wijck AJ, Schellevis FG, Kalkman CJ,
Verheij TJ.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, The Netherlands. w.opstelten@med.uu.nl

BACKGROUND: The main complications of herpes zoster (HZ) are postherpetic
neuralgia and, in case of HZ ophthalmicus, eye disorders. Antiviral treatment may
modify the course of disease and reduce the risk of complications. OBJECTIVE: To 
assess which doctors' and patients' characteristics were related to prescription 
of antiviral therapy for HZ. METHODS: Ninety general practices (358 008 patients)
in The Netherlands registered all patient contacts in a database for one year as 
part of the Second Dutch National Survey of General Practice. The present study
used ICPC code S70 to search that database for patients with a new diagnosis of
HZ. The full-text medical records of the selected patients were then reviewed and
the potential determinants for the prescription of antiviral drugs (including
characteristics of patients, GPs, and practices) analysed using multilevel
logistic regression modelling. RESULTS: Of the 1129 patients diagnosed with HZ
(incidence 3.2/1000 patients/year), 22.5% received antiviral drugs. Independent
determinants for prescription of antiviral therapy were age [45-54 years:
adjusted odds ratio (OR) 2.9 (95% CI 1.6-5.0); 55-64 years: OR 4.2 (95% CI
2.4-7.6); 65-74 years: OR 5.1 (95% CI 2.7-9.6); > or =75 years: OR 8.1 (95% CI
4.4-15.1)], ophthalmic localisation of the shingles (OR 3.2, 95% CI 1.6-6.7), and
the presence of asthma/COPD (OR 1.6, 95% CI 1.0-2.6). GPs who reported to
strongly adhere to professional guidelines prescribe more frequently antiviral
drugs (OR 1.9, 95% CI 1.2-3.1). CONCLUSIONS: A minority of HZ patients were
prescribed antiviral treatment. Increasing age, ophthalmic localisation, presence
of asthma/COPD, and adherence to professional guidelines were factors favouring
prescription. More information on the determinants of GPs' treatment decisions is
necessary for successful implementation of HZ guidelines.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16006497 [PubMed - indexed for MEDLINE]

689: Int J STD AIDS. 2005 Jul;16(7):475-8.

Herpes zoster as an immune restoration disease in AIDS patients during therapy
including protease inhibitors.

Dunic I, Djurkovic-Djakovic O, Vesic S, Zerjav S, Jevtovic D.

Institute of Dermatovenereology, School of Medicine, University of Belgrade,
Belgrade. iva001@eunet.yu

A prospective study to evaluate the incidence of herpes zoster (HZ) as an immune 
restoration disease in patients with AIDS during highly active antiretroviral
therapy (HAART) was conducted in a series of 115 patients diagnosed with AIDS
initiated on HAART between 1 January 2000 and 31 July 2001. Of these, a single
dermatomal HZ episode occurred in 14 (12%) patients within one and 15 months of
HAART (median eight months). The HZ patients were similar to the non-HZ patients 
in age, sex, and HIV transmission risk factor, but had a more advanced disease.
Compared with the baseline values, the viral loads significantly (P<0.01)
decreased, while the mean CD4+ T-cell counts increased by almost four-fold
(P<0.01) in both groups at the time of the HZ episode (or equivalent in non-HZ), 
but remained below 400/mL in the HZ patients. HZ during HAART is an
immunopathological consequence of the improvement of the host immuneresponse,
correlating with the beginning of immune restoration.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16004625 [PubMed - indexed for MEDLINE]

690: Arch Phys Med Rehabil. 2005 Jul;86(7):1492-4.

Segmental zoster paresis of the upper extremity: a case report.

Yoleri O, Olmez N, Oztura I, Sengul I, Gunaydin R, Memis A.

Physical Medicine and Rehabilitation department, Ataturk Training and Research
Hospital, Izmir, Turkey. yoleri@superonline.com

Segmental zoster paresis, a rare complication of herpes zoster, is characterized 
by focal, asymmetric motor weakness in the myotome that corresponds to the
dermatome of the rash. The pathogenesis of segmental zoster paresis is
inflammation caused by the spread of the herpes virus. Motor damage may affect
the root, plexus, or peripheral nerve. A woman in her early seventies with right 
shoulder pain and shoulder girdle muscle weakness was diagnosed with involvement 
of the C5-7 motor roots and upper truncus of the brachial plexus as a
complication of herpes zoster. Recognition of herpes zoster as a cause of acute
motor weakness is important in avoiding unnecessary interventions as well as in
determining the treatment and outcome of the patient. This case is presented to
emphasize that herpes zoster infection may be complicated by segmental paresis,
which should be considered in the differential diagnosis of acute painful motor
weakness of the upper extremity.

Publication Types: 
    Case Reports

PMID: 16003688 [PubMed - indexed for MEDLINE]

691: Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2005 Apr;19(7):297-9.

[Auditory brain stem response assessment in Ramsay Hunt syndrome]

[Article in Chinese]

Wu H, Yin S, Lu W, Yi H.

Department of Otorhinolaryngology and Ear Laboratory, Affiliated Sixth People's
Hospital of Shanghai Jiaotong University, Shanghai Hearing Measuring Center,
Shanghai, 200233, China.

OBJECTIVE: To discuss the changes of the auditory brain stem response in patients
with Ramsay Hunt syndrome. METHOD: Thirty-six patients of Ramsay Hunt
syndrome,who have only unilateral involvement with contralateral good ear, were
studied with pure tone test and auditory brain stem response. The latencies of
peaks I, III and V and interpeak latencies of I-III, I-V and III-V in bilateral
ears were analyzed by SPSS 10.0 for windows. RESULT: Compared to the
controlateral, the affected ears were significantly increased in latencies of II,
V and interpeak latencies of I-III, I-V ( P < 0.05). CONCLUSION: The audiological
data suggested that cochlear or retrocochlear involvement or involvement at more 
than one site along the auditory pathway existed in Ramsay Hunt syndrome, but
pure cochlear hearing loss is not common.

Publication Types: 
    English Abstract

PMID: 16001894 [PubMed - indexed for MEDLINE]

692: J Clin Microbiol. 2005 Jul;43(7):3290-6.

Sensitive and rapid detection of herpes simplex virus and varicella-zoster virus 
DNA by loop-mediated isothermal amplification.

Kaneko H, Iida T, Aoki K, Ohno S, Suzutani T.

Department of Microbiology, Fukushima Medical University School of Medicine, 1
Hikarigaoka, Fukushima 960-1295, Japan.

Loop-mediated isothermal amplification (LAMP) is a novel nucleic acid
amplification method in which reagents react rapidly and efficiently, with a high
specificity, under isothermal conditions. We used a LAMP assay for the detection 
of herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), and 
varicella-zoster virus (VZV). The virus specificities of primers were confirmed
by using 50 HSV-1, 50 HSV-2, and 8 VZV strains. The assay was performed for 45
min at 65 degrees C. The LAMP assay had a 10-fold higher sensitivity than a PCR
assay. An analysis of nucleotide sequence variations in the target and primer
regions used for the LAMP assay indicated that 3 of 50 HSV-1 strains had single
nucleotide polymorphisms. No HSV-2 or VZV strains had nucleotide polymorphisms.
Regardless of the sequence variation, there were no differences in sensitivity
with the HSV-1-specific LAMP assay. To evaluate the application of the LAMP assay
for clinical diagnosis, we tested clinical samples from 40 genital herpes
patients and 20 ocular herpes patients. With the LAMP assay, 41 samples with DNA 
extraction and 26 direct samples without DNA extraction were identified as
positive for HSV-1 or HSV-2, although 37 samples with DNA extraction and just one
without DNA extraction were positive by a PCR assay. Thus, the LAMP assay was
less influenced than the PCR assay by the presence of inhibitory substances in
clinical samples. These observations indicate that the LAMP assay is very useful 
for the diagnosis of HSV-1, HSV-2, and VZV infections.

Publication Types: 
    Evaluation Studies

PMID: 16000450 [PubMed - indexed for MEDLINE]

693: J Neurol. 2005 Jul;252(7):869-71.

Vaccination against herpes zoster, small RNA against ALS and IgG antibodies in
stiff-person syndrome.

Strupp M.

Dept. of Neurology, Ludwig-Maximilians University, Klinikum Grosshadern,
Marchioninistr. 15, 81366 Munich, Germany. Michael.Strupp@med.uni-muenchen.de

Publication Types: 
    Comparative Study

PMID: 15999237 [PubMed - indexed for MEDLINE]

694: Haematologica. 2005 Jul;90(7):996-7.

Analysis of the efficacy and toxicity of bortezomib for treatment of relapsed or 
refractory multiple myeloma in community practice.

Wu KL, van Wieringen W, Vellenga E, Zweegman S, Lokhorst HM, Sonneveld P.

The clinical data on the efficacy and toxicity of bortezomib as treatment for
multiple myeloma patients are restricted to prospective phase II studies in
expert myeloma centers. Here we report a multi-institutional analysis of the
efficacy and toxicity of bortezomib in patients with relapsed or refractory
multiple myeloma who were treated in community centers in a compassionate need
program.

Publication Types: 
    Clinical Trial
    Letter

PMID: 15996946 [PubMed - indexed for MEDLINE]

695: Neurologist. 2005 Jul;11(4):244-9.

Facial pain.

Hentschel K, Capobianco DJ, Dodick DW.

Mayo Clinic College of Medicine, Mayo Graduate School of Medicine, Jacksonville, 
FL, USA.

Facial pain is a common symptom that may be a feature of a primary headache
disorder or a secondary feature of organic disease. A thorough clinical history
and physical examination may reveal the characteristic clinical features and
assist in diagnosis. However, in some cases, the etiology may remain
indeterminate.

Publication Types: 
    Case Reports
    Review

PMID: 15989697 [PubMed - indexed for MEDLINE]

696: Prescrire Int. 2005 Jun;14(77):85-91.

Chickenpox vaccines: new drugs. A favourable risk-benefit balance in some
situations.

[No authors listed]

(1) Chickenpox is generally mild. Most severe cases of chickenpox occur in
immunocompromised patients, adults, and pregnant women (and their foetuses). (2) 
Two live attenuated chickenpox vaccines derived from the same strain of varicella
virus (Oka) are marketed in France, under the trade names Varilrix and Varivax.
(3) They have not been adequately evaluated in immunocompromised children. (4)
The impact of routine vaccination of women of child-bearing age on complications 
of chickenpox during pregnancy has not been studied. (5) Immunogenicity studies
in several thousand immunocompetent children aged from 1 to 12 years show that
the vaccine is almost always immunogenic after a single injection. Other
comparative studies in adolescents and adults show that two injections are
needed, at least two months apart. (6) A double-blind placebo-controlled trial
including 513 immunocompetent children showed that Varilrix prevented 88% of
cases of chickenpox after a median follow-up of 29 months, but no data on severe 
chickenpox were reported. A study that followed up 9202 children aged 1 to 12
years for more than 13 years showed that vaccination with Varivax failed to
prevent chickenpox in 12.5% of cases and that 1.7% of these cases were severe.
(7) Immunocompetent children vaccinated within three days after exposure to the
virus are partially protected, according to one study of Varilrix (104 children) 
and two small studies of Varivax (10 and 42 children). There are no equivalent
studies in adults. (8) Local adverse effects such as fever and rash are common in
immunocompetent vaccinees. The rash is sometimes varicella-like and is due to
infection by the vaccine strain. Pharmacovigilance studies of Varivax have shown 
no serious adverse effects. (9) Disseminated and/or persistent infection caused
by the vaccine strain has been reported in immunocompromised patients. (10)
Vaccination of immunocompetent subjects does not appear to result in a risk of
chickenpox transmission to subsequent contacts. There seems to be no increase in 
the risk of herpes zoster in vaccinated children nor is there any firm evidence
that chickenpox vaccination increases the incidence of herpes zoster in the
general population. (11) Little information is available on vaccination during
pregnancy. As a precaution, however, pregnant women should not be vaccinated.
(12) Mass vaccination does not appear to be justified: chickenpox is generally
mild during childhood, and several questions concerning the effects of the
vaccine remain unanswered. (13) Chickenpox vaccination should be restricted to
specific groups of non immune immunocompetent adults who are in a position to
transmit chickenpox to immunodeficient contacts (e.g. health care personnel and
kindergarten staff); adults who have been in contact with a case of chickenpox
within the past three days; and children awaiting transplantation. The potential 
benefits and risks of vaccinating immunocompromised patients should be assessed
on a case by case basis.

Publication Types: 
    Comparative Study

PMID: 15977369 [PubMed - indexed for MEDLINE]

697: Time. 2005 Jun 13;165(24):67.

A shingles vaccine.

Gorman C.

Publication Types: 
    News

PMID: 15974024 [PubMed - indexed for MEDLINE]

698: J Neurol Sci. 2005 Oct 15;237(1-2):97-101.

Unilateral retrobulbar optic neuritis due to varicella zoster virus in a patient 
with AIDS: a case report and review of the literature.

Liu JZ, Brown P, Tselis A.

Department of Anesthesiology, Detroit Medical Center, Wayne State University,
Detroit, MI 48201, United States.

Unilateral retrobulbar optic neuritis developed in a 43-year-old man with
acquired immune deficiency syndrome (AIDS). This was secondary to varicella
zoster virus (VZV) as confirmed by cerebrospinal fluid (CSF) polymerase chain
reaction (PCR) detection of VZV in the cerebrospinal fluid. There was no typical 
cutaneous infection and no evidence of retinitis. The onset of unexplained visual
loss due to optic neuritis in HIV positive individuals may be due to VZV
infection. Prompt recognition, and early intervention with antiVZV therapy may
preserve vision. Retrobulbar optic neuritis secondary to VZV infection should be 
considered in immunocompromised patients even in the absence of cutaneous or
retinal lesions. Previous cases are reviewed and the varied nature of viral
transport in the nervous system is noted.

Publication Types: 
    Case Reports

PMID: 15972220 [PubMed - indexed for MEDLINE]

699: Br J Ophthalmol. 2005 Jul;89(7):923-4.

"Ecstasy" induced immunosuppression and herpes zoster ophthalmicus.

Zwick OM, Fischer DH, Flanagan JC.

Publication Types: 
    Case Reports
    Letter

PMID: 15965183 [PubMed - indexed for MEDLINE]

700: J Virol Methods. 2005 Sep;128(1-2):162-7.

Development and evaluation of Varicella zoster virus ELISA for oral fluid
suitable for epidemiological studies.

Talukder Y, Gopal R, Andrews N, Glenn M, Breuer J, Brown D.

Centre for Infectious Disease, Department of Virology, Barts and The London
School of Medicine and Dentistry, 25-29 Ashfield St., London E1 1BB, UK.
ingrej@gmail.com

An enzyme-linked immunosorbent assay (ELISA) for detection of Varicella zoster
virus (VZV) antibodies in oral fluid is described. The assay was optimised and
evaluated using paired serum and oral fluid from healthy adult volunteers (n =
205) and preschool children (n = 98), oral fluid samples collected for routine
measles, mumps and rubella testing (n = 537) and samples from a study of atopic
dermatitis (n = 252). As chickenpox is predominantly a childhood disease and most
adults are immune, it was crucial to have samples from children aged 1-5 years to
evaluate the assay. Mixture modelling of the oral fluid results was used to
determine the optimum cut-off, sensitivity and specificity of the assay. Compared
to paired sera tested by the same ELISA the sensitivity of the oral fluid assay
was 93% and specificity 95.7% overall, varying slightly with age group. The assay
was shown to have good potential for use in large-scale epidemiological studies.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 15961168 [PubMed - indexed for MEDLINE]

701: BMC Public Health. 2005 Jun 16;5(1):68.

The incidence of varicella and herpes zoster in Massachusetts as measured by the 
Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing 
varicella vaccine coverage, 1998-2003.

Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, Seward JF.

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard 
Pilgrim Health Care, Boston, USA. katherine_yih@harvardpilgrim.org

BACKGROUND: The authors sought to monitor the impact of widespread varicella
vaccination on the epidemiology of varicella and herpes zoster. While varicella
incidence would be expected to decrease, mathematical models predict an initial
increase in herpes zoster incidence if re-exposure to varicella protects against 
reactivation of the varicella zoster virus. METHODS: In 1998-2003, as varicella
vaccine uptake increased, incidence of varicella and herpes zoster in
Massachusetts was monitored using the random-digit-dial Behavioral Risk Factor
Surveillance System. RESULTS: Between 1998 and 2003, varicella incidence declined
from 16.5/1,000 to 3.5/1,000 (79%) overall with > or = 66% decreases for all age 
groups except adults (27% decrease). Age-standardized estimates of overall herpes
zoster occurrence increased from 2.77/1,000 to 5.25/1,000 (90%) in the period
1999-2003, and the trend in both crude and adjusted rates was highly significant 
(p < 0.001). Annual age-specific rates were somewhat unstable, but all increased,
and the trend was significant for the 25-44 year and 65+ year age groups.
CONCLUSION: As varicella vaccine coverage in children increased, the incidence of
varicella decreased and the occurrence of herpes zoster increased. If the
observed increase in herpes zoster incidence is real, widespread vaccination of
children is only one of several possible explanations. Further studies are needed
to understand secular trends in herpes zoster before and after use of varicella
vaccine in the United States and other countries.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15960856 [PubMed - indexed for MEDLINE]

702: Med Monatsschr Pharm. 2005 Jun;28(6):188-92.

[Chickenpox (Varicella) and shingles (Herpes zoster)]

[Article in German]

[No authors listed]

PMID: 15960420 [PubMed - indexed for MEDLINE]

703: Nippon Rinsho. 2005 May;63 Suppl 5:619-24.

[Varicella-zoster virus vaccine]

[Article in Japanese]

Asano Y.

Department of Pediatrics, Fujita Health University School of Medicine.

Publication Types: 
    Review

PMID: 15954419 [PubMed - indexed for MEDLINE]

704: Clin Neurophysiol. 2005 Jul;116(7):1542-54.

Excitability of facial nucleus and related brain-stem reflexes in hemifacial
spasm, post-facial palsy synkinesis and facial myokymia.

Oge AE, Yayla V, Demir GA, Eraksoy M.

Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Capa 
34390, Istanbul, Turkey. aemreoge@superonline.com

OBJECTIVE: To compare the electrophysiological excitability characteristics of
the facial nucleus and related structures in hemifacial spasm (HFS), post-facial 
palsy synkinesis (PFPS) and facial myokymia (FM). METHODS: Facial F-waves, blink 
reflex recoveries and magnetically elicited silent periods (SP) were
prospectively studied in 17 HFS, 17 PFPS, 8 FM cases and in 13 controls. Earlier 
unpublished observations on abnormal impulse transmission in 36 HFS and 29 PFPS
cases were also included. RESULTS: Enhanced F-waves were recorded on the
symptomatic side in PFPS and HFS cases with a tendency to be more pronounced in
PFPS. HFS and PFPS groups both showed an earlier blink reflex recovery, more
prominent in PFPS patients, when stimulated and/or recorded on the symptomatic
side. Unelicitable SPs were encountered after 24/39 stimulations in 5 patients
with PFPS and rarely in HFS cases. Duration of elicitable SPs did not change
remarkably. FM group had similar characteristics as normal controls in the 3
electrophysiological tests. Latencies of the lateral and synkinetic spread
responses were significantly prolonged in the earlier PFPS group as compared to
HFS. In two-point stimulation, both groups showed a greater latency shift in late
responses, again more pronounced in PFPS. CONCLUSIONS: PFPS and HFS cases had
similar enhanced excitability patterns at the facial nucleus and related
brain-stem structures, more marked on the symptomatic side and more obvious in
the PFPS group. Findings elicited in the FM group were thought to be caused by
asynchronous hyperactivity of facial motoneurons. SIGNIFICANCE: In this
comparative electrophysiological study, similar excitability patterns were found 
in HFS and PFPS groups, albeit with different intensities.

Publication Types: 
    Comparative Study

PMID: 15953558 [PubMed - indexed for MEDLINE]

705: Am J Ophthalmol. 2005 Jun;139(6):1135-6.

Comment in:
    Am J Ophthalmol. 2006 Apr;141(4):782; author reply 782.

Chronic recurrent varicella-zoster virus keratitis confirmed by polymerase chain 
reaction testing.

Magone MT, Nasser RE, Cevallos AV, Margolis TP.

Francis I. Proctor Foundation, University of California-San Francisco, San
Francisco, CA 94143-0944, USA. tm@magones.com

PURPOSE: To report a case of chronic recurrent varicella virus epithelial
keratitis in a child. DESIGN: Case report. METHODS: Clinical examination and
polymerase chain reaction analysis of corneal epithelium. RESULTS: A 10-year-old 
healthy child developed chronic recurrent varicella virus keratitis with
pseudodendrites after recovering from systemic varicella. Analysis of the
debrided pseudodendrites was repeatedly positive for VZV DNA and negative for HSV
DNA. Treatment with oral acyclovir and topical corticosteroid drops was effective
in eliminating the pseudodendrites; however, recurrences occurred once the
medications were discontinued. CONCLUSIONS: Varicella virus epithelial keratitis 
in children can be a recurrent chronic condition requiring prolonged treatment.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15953460 [PubMed - indexed for MEDLINE]

706: Saudi Med J. 2005 May;26(5):869-71.

Congenital varicella-zoster virus infection. A rare case of severe brain and
ocular malformations without limb or cutaneous involvement in a newborn after
maternal subclinical infection.

Al-Katawee YA, Al-Hasoun YA, Taha MN, Al-Moslem K.

Department of Neonatology Al-Yamamah Hospital, PO Box 106208, Riyadh 11666,
Kingdom of Saudi Arabia. yrshmh@hotmail.com

Although congenital varicella-zoster virus VZV infection is rare, it carries
serious morbidity and mortality to the fetus and newborn infant. We report a full
term female newborn infant, born to a multipara unbooked mother who had VZV
subclinical infection during the first trimester of pregnancy. Routine newborn
examination showed cystic malformation of the left eye, and absence of the right 
eye globe. Radiological work up revealed severe brain and eye malformations,
serological studies of both mother and baby were positive for VZV. The baby
underwent palliative surgery to the eyes, upon discharge, a plan of
multidisciplinary team was made for follow up including neurologist,
ophthalmologist, pediatrician and social worker. Congenital VZV infection can be 
severe enough to cause catastrophic fetal anomalies and damage to the vital
organs as many of those infants die in infancy.

Publication Types: 
    Case Reports

PMID: 15951887 [PubMed - indexed for MEDLINE]

707: J Hand Surg [Br]. 2005 Aug;30(4):355-7.

Herpes zoster in the ulnar nerve distribution.

Athwal GS, Bartsich SA, Weiland AJ.

Hand and Upper Limb Centre, University of Western Ontario, London, Ontario,
Canada.

Varicella zoster is a ubiquitous virus which usually affects school-aged children
as Chicken Pox. While the initial disease is self-limiting and seldom severe, the
virus remains in the body. It lies dormant in the dorsal root ganglia and
reactivation may occur years later with variable presentations as Herpes Zoster, 
or Shingles. While Shingles is common, it rarely presents exclusively in the
upper extremity. It is important that hand surgeons recognize the possibility of 
zoster infection, with or without a rash, when evaluating the onset of neuralgia 
in a dermatomal distribution in the upper limb. Early diagnosis allows rapid and 
appropriate treatment, with a lower risk of complications. We report on a case of
Herpes Zoster isolated to the ulnar nerve distribution in a young woman.

Publication Types: 
    Case Reports

PMID: 15950335 [PubMed - indexed for MEDLINE]

708: J Pain. 2005 Jun;6(6):356-63.

Pain, medication use, and health-related quality of life in older persons with
postherpetic neuralgia: results from a population-based survey.

Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD.

Policy Analysis Inc, Brookline, Massachusetts 02445, USA. goster@pai2.com

Persons aged >65 years with pain caused by postherpetic neuralgia (PHN) were
recruited via advertisements in 24 US newspapers and were mailed a questionnaire 
that addressed pain intensity (average, worst, least, current), pain interference
(with general activity, mood, relations with other people, sleep, enjoyment of
life), and health-related quality of life (using the EuroQoL health measure
[EQ-5D] and a global rating scale). Respondents also were asked about their use
of medication for shingles pain. A total of 385 persons completed the survey; 61%
were >75 years of age. Mean (+/-standard deviation) duration of PHN was 3.3
(+/-4.0) years. Only about one half had taken prescription medication for
shingles pain during the prior week; dosages were typically low. Mean average,
worst, least, and current pain caused by shingles (0- to 10-point scale) was 4.6 
(+/-2.1), 6.0 (+/-2.4), 2.9 (+/-2.3), and 4.0 (+/-2.7), respectively. Mean pain
interference with general activity, mood, relations with other people, sleep, and
enjoyment of life (0- to 10-point scale) was 3.7 (+/-3.1), 4.3 (+/-2.9), 3.0
(+/-2.8), 3.8 (+/-2.9), and 4.5 (+/-3.1), respectively. The mean EQ-5D health
index score was 0.61; respondents rated their overall health as 65.7 (+/-21.1) on
a 100-point scale. PHN causes substantial pain, dysfunction, and poor
health-related quality of life in older persons, many of whom might be
suboptimally treated. PERSPECTIVE: Many older persons (age >65 years) with PHN
experience longstanding, severe, and debilitating pain and poor health-related
quality of life; levels of dissatisfaction with treatment are high. Our study
highlights the need for improved management of this disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15943957 [PubMed - indexed for MEDLINE]

709: Am J Transplant. 2005 Jul;5(7):1777-80.

Concurrent verrucous and varicelliform rashes following renal transplantation.

Jeyaratnam D, Robson AM, Hextall JM, Wong W, MacMahon E.

Department of Infection, St John's Institute of Dermatology, St Thomas' Hospital,
London SE1 7EH, UK.

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.

Publication Types: 
    Case Reports
    Review

PMID: 15943639 [PubMed - indexed for MEDLINE]

710: Int J Dermatol. 2005 Jun;44(6):524-5.

Morphea with features of lichen sclerosus et atrophicus at the site of a herpes
zoster scar: another case of an isotopic response.

Forschner A, Metzler G, Rassner G, Fierlbeck G.

Publication Types: 
    Case Reports
    Letter

PMID: 15941448 [PubMed - indexed for MEDLINE]

711: MMW Fortschr Med. 2005 May 5;147(18):35-8.

[Problems and diseases of the aging skin]

[Article in German]

Goebeler M, Brocker EB.

Klinik fur Dermatologie, Venerologie und Allergologie, Klinikum Mannheim gGmbH,
Universitatsklinikum, Ruprecht-Karls-Universitat Heidelberg.

Publication Types: 
    Review

PMID: 15934586 [PubMed - indexed for MEDLINE]

712: N Engl J Med. 2005 Jun 2;352(22):2344-6.

Comment in:
    N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5.

Comment on:
    N Engl J Med. 2005 Jun 2;352(22):2271-84.

Varicella-zoster virus vaccine--grown-ups need it, too.

Gilden DH.

Publication Types: 
    Comment
    Editorial

PMID: 15930426 [PubMed - indexed for MEDLINE]

713: N Engl J Med. 2005 Jun 2;352(22):2271-84.

Comment in:
    ACP J Club. 2005 Nov-Dec;143(3):61.    N Engl J Med. 2005 Jun 2;352(22):2266-7.    N Engl J Med. 2005 Jun 2;352(22):2344-6.    N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5.    N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5.    N Engl J Med. 2007 Jul 5;357(1):89.    Nat Clin Pract Neurol. 2005 Nov;1(1):18-9.

A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.

Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, Arbeit RD,
Simberkoff MS, Gershon AA, Davis LE, Weinberg A, Boardman KD, Williams HM, Zhang 
JH, Peduzzi PN, Beisel CE, Morrison VA, Guatelli JC, Brooks PA, Kauffman CA,
Pachucki CT, Neuzil KM, Betts RF, Wright PF, Griffin MR, Brunell P, Soto NE,
Marques AR, Keay SK, Goodman RP, Cotton DJ, Gnann JW Jr, Loutit J, Holodniy M,
Keitel WA, Crawford GE, Yeh SS, Lobo Z, Toney JF, Greenberg RN, Keller PM,
Harbecke R, Hayward AR, Irwin MR, Kyriakides TC, Chan CY, Chan IS, Wang WW,
Annunziato PW, Silber JL; Shingles Prevention Study Group.

Shingles Prevention Study (Mail code 111F-1), VA San Diego Healthcare System,
3350 La Jolla Village Dr., San Diego, CA 92161,USA. mnoxman@ucsd.edu

BACKGROUND: The incidence and severity of herpes zoster and postherpetic
neuralgia increase with age in association with a progressive decline in
cell-mediated immunity to varicella-zoster virus (VZV). We tested the hypothesis 
that vaccination against VZV would decrease the incidence, severity, or both of
herpes zoster and postherpetic neuralgia among older adults. METHODS: We enrolled
38,546 adults 60 years of age or older in a randomized, double-blind,
placebo-controlled trial of an investigational live attenuated Oka/Merck VZV
vaccine ("zoster vaccine"). Herpes zoster was diagnosed according to clinical and
laboratory criteria. The pain and discomfort associated with herpes zoster were
measured repeatedly for six months. The primary end point was the burden of
illness due to herpes zoster, a measure affected by the incidence, severity, and 
duration of the associated pain and discomfort. The secondary end point was the
incidence of postherpetic neuralgia. RESULTS: More than 95 percent of the
subjects continued in the study to its completion, with a median of 3.12 years of
surveillance for herpes zoster. A total of 957 confirmed cases of herpes zoster
(315 among vaccine recipients and 642 among placebo recipients) and 107 cases of 
postherpetic neuralgia (27 among vaccine recipients and 80 among placebo
recipients) were included in the efficacy analysis. The use of the zoster vaccine
reduced the burden of illness due to herpes zoster by 61.1 percent (P<0.001),
reduced the incidence of postherpetic neuralgia by 66.5 percent (P<0.001), and
reduced the incidence of herpes zoster by 51.3 percent (P<0.001). Reactions at
the injection site were more frequent among vaccine recipients but were generally
mild. CONCLUSIONS: The zoster vaccine markedly reduced morbidity from herpes
zoster and postherpetic neuralgia among older adults. Copyright 2005
Massachusetts Medical Society.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 15930418 [PubMed - indexed for MEDLINE]

714: N Engl J Med. 2005 Jun 2;352(22):2266-7.

Comment on:
    N Engl J Med. 2005 Jun 2;352(22):2271-84.

Aging, immunity, and the varicella-zoster virus.

Arvin A.

Stanford University School of Medicine, Stanford, Calif, USA.

Publication Types: 
    Comment

PMID: 15930416 [PubMed - indexed for MEDLINE]

715: JAMA. 2005 May 25;293(20):2459-60.

When shingles wanes but pain does not: researchers target chronic postherpetic
neuralgia.

Hampton T.

Publication Types: 
    News

PMID: 15914732 [PubMed - indexed for MEDLINE]

716: Am J Dermatopathol. 2005 Jun;27(3):189-94.

Exclusive involvement of folliculosebaceous units by herpes: a reflection of
early herpes zoster.

Walsh N, Boutilier R, Glasgow D, Shaffelburg M.

Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
noreen.walsh@cdha.nshealth.ca

The histopathological changes of herpes simplex, herpes zoster, and varicella are
considered to be indistinguishable from one another. Evaluation of the clinical
setting, with adjunctive studies if necessary, generally clarifies the specific
diagnosis. Vesicular lesions in all three conditions can involve epidermal and
adnexal epithelium with characteristic cytopathic features. We describe three
patients with non-vesicular eruptions on the head and neck whose biopsies
revealed exclusive folliculosebaceous involvement by herpes. All three patients
developed typical herpes zoster within days of the biopsy. There is compelling
scientific evidence in the literature indicating that, in herpes zoster, the
virus is transported from dorsal root or trigeminal ganglia via myelinated nerves
to the skin. These terminate at the isthmus of hair follicles and primary
infection of follicular and sebaceous epithelium occurs. Spread of infection to
the epidermis follows. In contrast, data pertaining to recurrent herpes simplex
indicates that axonal transport of the virus from sensory ganglia to the skin is 
directed primarily to the epidermis, via terminal non-myelinated nerve twigs. The
clinical evolution of our three cases and scientific data in the literature
indicate that exclusive folliculosebaceous involvement by herpes, in the setting 
of a non-vesicular eruption, represents early herpes zoster.

Publication Types: 
    Case Reports

PMID: 15900120 [PubMed - indexed for MEDLINE]

717: J Infect Dis. 2005 Jun 15;191(12):2002-7. Epub 2005 May 12.

Comment in:
    J Infect Dis. 2005 Jun 15;191(12):1999-2001.

Incidence of herpes zoster, before and after varicella-vaccination-associated
decreases in the incidence of varicella, 1992-2002.

Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia 30345, USA.
ajumaan@cdc.gov

BACKGROUND: Varicella zoster virus (VZV) causes varicella and, later in the life 
of the host, may reactivate to cause herpes zoster (HZ). Because it is
hypothesized that exposure to varicella may boost immunity to latent VZV, the
vaccination-associated decrease in varicella disease has led some to suggest that
the incidence of HZ might increase. We assessed the impact that varicella
vaccination has on the incidence of varicella and of HZ. METHODS: Codes for cases
of varicella and of HZ in an HMO were determined in automated databases of
inpatients and outpatients, on the basis of the Ninth Revision of the
International Classification of Diseases. We calculated the incidence, during
1992-2002, of varicella and of HZ. RESULTS: The incidence of HZ remained stable
as the incidence of varicella decreased. Age-adjusted and -specific annual
incidence rates of varicella decreased steadily, starting with 1999. The
age-adjusted rates decreased from 2.63 cases/1000 person-years during 1995 to
0.92 cases/1000 person-years during 2002; among children 1-4 years old, there was
a 75% decrease between 1992-1996 and 2002. Age-adjusted and -specific annual
incidence rates of HZ fluctuated slightly over time; the age-adjusted rate was
highest, at 4.05 cases/1000 person-years, in 1992, and was 3.71 cases/1000
person-years in 2002. CONCLUSIONS: Our findings revealed that the
vaccination-associated decrease in varicella disease did not result in an
increase in the incidence of HZ. These early findings will have to be confirmed
as the incidence of varicella disease continues to decrease.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15897984 [PubMed - indexed for MEDLINE]

718: J Infect Dis. 2005 Jun 15;191(12):1999-2001. Epub 2005 May 12.

Comment on:
    J Infect Dis. 2005 Jun 15;191(12):2002-7.

Changing dynamics of varicella-zoster virus infections in the 21st century: the
impact of vaccination.

Whitley RJ.

Publication Types: 
    Comment
    Editorial

PMID: 15897983 [PubMed - indexed for MEDLINE]

719: Pediatr Infect Dis J. 2005 May;24(5):476-7.

Varicella zoster virus encephalitis in a previously healthy five-year-old child
with herpes zoster ophthalmicus.

Ofek-Shlomai N, Averbuch D, Wolf DG, Engelhard D.

Publication Types: 
    Case Reports
    Letter

PMID: 15876958 [PubMed - indexed for MEDLINE]

720: Am J Epidemiol. 2005 May 15;161(10):929-38.

History of chickenpox and shingles and prevalence of antibodies to
varicella-zoster virus and three other herpesviruses among adults with glioma and
controls.

Wrensch M, Weinberg A, Wiencke J, Miike R, Sison J, Wiemels J, Barger G,
DeLorenze G, Aldape K, Kelsey K.

Department of Neurological Surgery, School of Medicine, University of California,
San Francisco, CA 94102, USA. wrensch@itsa.ucsf.edu

Whether viruses or immunologic factors might cause or prevent human brain cancer 
is of interest. Statistically significant inverse associations of adult glioma
with history of chickenpox and immunoglobulin G antibodies to varicella-zoster
virus have been reported. The authors evaluate associations of immunoglobulin G
antibodies to varicella-zoster virus and three other herpesviruses among 229
adults with glioma and 289 controls in the San Francisco Bay Area Adult Glioma
Study (1997-2000). Cases were less likely than controls to report a history of
chickenpox (for self-reported cases vs. controls: the age-, gender-, and
ethnicity-adjusted odds ratio = 0.59, 95% confidence interval: 0.40, 0.86), and
they also had lower levels of immunoglobulin G to varicella-zoster virus (for
being in the highest quartile vs. the lowest quartile: the age-, gender-, and
ethnicity-adjusted odds ratio = 0.41, 95% confidence interval: 0.24, 0.70). The
inverse association with anti-varicella-zoster virus immunoglobulin G was most
marked for glioblastoma multiforme cases versus controls and was only somewhat
attenuated by excluding subjects taking high-dose steroids and other medications.
Cases and controls did not differ notably for positivity to three other
herpesviruses, Epstein-Barr virus, cytomegalovirus, and herpes simplex virus.
Cohort studies may help to clarify the nature of the association between immunity
to and/or clinical manifestations of varicella-zoster virus and glioblastoma.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15870157 [PubMed - indexed for MEDLINE]

721: Ir Med J. 2005 Mar;98(3):68.

Is it time to introduce varicella vaccination?

Murphy JF.

PMID: 15869059 [PubMed - indexed for MEDLINE]

722: J Dermatol. 2005 Apr;32(4):311-2.

Giant annular lichen planus: wolf's isotopic response.

Choi HJ, Kim KJ, Lee MW, Choi JH, Moon KC, Koh JK.

Publication Types: 
    Case Reports
    Letter

PMID: 15863859 [PubMed - indexed for MEDLINE]

723: Clin Infect Dis. 2005 May 15;40(10):1545-7. Epub 2005 Apr 13.

A case of Ramsay Hunt-like syndrome caused by herpes simplex virus type 2.

Diaz GA, Rakita RM, Koelle DM.

Department of Medicine, University of Washington, Seattle, WA, USA.
geodiaz@u.washington.edu

We report an immunocompetent patient with recurrent auricular and facial vesicles
associated with painful paresthesias and facial paralysis, consistent with Ramsay
Hunt syndrome, due to herpes simplex virus (HSV) type 2. Clinical and
laboratory-proven acyclovir resistance developed during therapy. Immunologic
assays revealed normal reactivity to HSV-2.

Publication Types: 
    Case Reports

PMID: 15844081 [PubMed - indexed for MEDLINE]

724: Emerg Med J. 2005 May;22(5):384-6.

The reawakening of a sleeping little giant.

Goddard R.

General Surgery, Queen Elizabeth and Queen Mary Hospitals, East Kent Hospitals
NHS Trust. goddard1998@aol.com

This case report and literature review highlights the classical signs and
symptoms of herpes zoster infection involving the trigeminal nerve. Incorrect
diagnosis leads to delay in providing effective treatment and could result in
failure to identify potentially hazardous ocular complications and to prevent
chronic post-herpetic pain.

Publication Types: 
    Case Reports
    Review

PMID: 15843717 [PubMed - indexed for MEDLINE]

725: Evid Based Complement Alternat Med. 2005 Mar;2(1):113-116.

Mind-Body, Ki (Qi) and the Skin: Commentary on Irwin's 'Shingles Immunity and
Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment'

Kobayashi H, Ishii M.

PMID: 15841287 [PubMed - as supplied by publisher]

726: Vaccine. 2005 May 9;23(25):3349-55.

Cost-benefit analysis of universal varicella vaccination in the U.S. taking into 
account the closely related herpes-zoster epidemiology.

Goldman GS.

Medical Veritas International (MVI), Pearblossom, CA 93553, USA.
pearblossominc@aol.com

Many models concur that universal varicella vaccination of children is beneficial
from the perspective of reducing societal costs. Yet, the majority of such cost
analyses have been modeled under the assumption that varicella vaccination has no
adverse effect on the closely related herpes-zoster (HZ) epidemiology. Historical
models have assumed that asymptomatic endogenous reactivation is the chief
mechanism of boosting that suppresses the reactivation of HZ and that immunity
wanes due to the aging process. Recent studies suggest instead that periodic
exogenous exposures to wild-type varicella are the predominant factor influencing
the curve of increasing HZ incidence rate with advancing age among individuals
<50, after which an age-related decline dominates in the elderly. Based on a
realistic age-structured model, we compare differences in outcomes of the number 
of HZ cases and direct medical costs associated with the population existing in
2000 and as it ages (according to the mortality given in the 2000 U.S. census)
during the following 50 years with and without implementation of universal
varicella vaccination. Under universal varicella vaccination, we assume that 15
years post-licensure, the boosting mechanism known as asymptomatic endogenous
reactivation principally serves to limit HZ incidence to 550 per 100,000
person-years in unvaccinated individuals <50 with a previous history of natural
varicella--since there has been a vaccine-induced decline in exogenous boosting. 
We estimate universal varicella vaccination has the impact of an additional 14.6 
million (42%) HZ cases among adults aged <50 years during a 50 year time span at 
a substantial cost burden of 4.1 billion US dollars or 80 million US dollars
annually utilizing an estimated mean healthcare provider cost of 280 US dollars
per HZ case.

PMID: 15837242 [PubMed - indexed for MEDLINE]

727: Ann Rheum Dis. 2005 May;64(5):780-2.

Human parvovirus B19, varicella zoster virus, and human herpes virus 6 in
temporal artery biopsy specimens of patients with giant cell arteritis: analysis 
with quantitative real time polymerase chain reaction.

Alvarez-Lafuente R, Fernandez-Gutierrez B, Jover JA, Judez E, Loza E, Clemente D,
Garcia-Asenjo JA, Lamas JR.

Rheumatology Service, Hospital Clinico San Carlos, Madrid, Spain.

OBJECTIVE: To evaluate the role of parvovirus B19 (B19), varicella zoster virus
(VZV), and human herpes virus 6 (HHV-6) in the aetiopathology of giant cell
arteritis (GCA). METHODS: Temporal artery biopsy specimens from 57 patients with 
GCA and 56 controls were investigated. DNA was obtained by biopsy, and
quantitative real time polymerase chain reaction assay performed to establish the
prevalence and viral load of B19, VZV, and HHV-6. Amplification of the human
beta-globin gene was used as internal positive control. RESULTS: (a) B19 was
detected in 31/57 (54%) patients (median viral load 45.2 (25th-75th centiles
0-180.2) copies/microg DNA) v 21/56 (38%) controls (median viral load 0 (0-66.7) 
copies/microg of DNA; p = 0.07 for DNA prevalence, p = 0.007 for viral load.
Among 31 B19 positive samples, 21 (68%) patients with biopsy proven GCA had
>10(2) B19 copies/microg of DNA v 5/21 (24%) controls; p = 0.001. (b) No
significant difference was found for VZV (p = 0.94 for DNA prevalence; p = 0.76
for viral load) and HHV-6 (p = 0.89 for DNA prevalence; p = 0.64 for viral load) 
in the GCA group compared with controls. CONCLUSION: B19 may have a role in the
aetiopathology of GCA, particularly in those patients with high viral load; no
evidence was found for VZV and HHV-6.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15834059 [PubMed - indexed for MEDLINE]

728: J Trop Pediatr. 2005 Jun;51(3):141-4. Epub 2005 Apr 14.

Varicella zoster seroprevalence in children less than 5 years old.

Ozkan S, Maral I, Ilhan F, Aycan S, Cirak MY, Beyazova U, Aygun R.

Gazi University Faculty of Medicine, Department of Public Health, Ankara, Turkey.
ozkans@gazi.edu.tr

This study was designed to evaluate the age-specific varicella-zoster virus (VZV)
seroprevalence in children less than 5 years old who presented at a healthy child
outpatient clinic and to compare the results with the data from other countries. 
The study was a cross-sectional study determining the prevalence of serum IgG
against VZV in children who presented to the Healthy Child Outpatient Clinic of
the Gazi University Medical Faculty and who were aged between 9 months and 5
years, in the 3rd--97th percentile as regards height and weight, not suffering
from any disease, and without a history of vaccination against varicella. The
information on the children was obtained from a questionnaire, by physical
examination, and from patient files. Serum samples were obtained from babies and 
children at 9, 15, 24, 36, 48, and 60 months. The 295 serum samples were kept at 
--20 degrees C following centrifugation until used for serologic analysis
(ELISA). The 292 children of the study group consisted of 168 males (57.5 per
cent) and 124 females (42.5 per cent). VZV antibodies were found to be positive
in 65 children aged between 9 months and 5 years (22.3 per cent); 22.0 per cent
in males and 22.6 per cent in females with no statistically significant
difference between the sexes (p>0.05). The VZV seroprevalence was highest at the 
48th and 60th months and this difference was statistically significant (p=0.000).

Publication Types: 
    Comparative Study

PMID: 15831668 [PubMed - indexed for MEDLINE]

729: J Virol. 2005 May;79(9):5315-25.

Array analysis of simian varicella virus gene transcription in productively
infected cells in tissue culture.

Deitch SB, Gilden DH, Wellish M, Smith J, Cohrs RJ, Mahalingam R.

Department of Neurology, Mail Stop B182, 4200 E. 9th Avenue, Denver, CO 80262,
USA.

Simian varicella virus (SVV) is a neurotropic alphaherpesvirus of monkeys that is
a model for varicella pathogenesis and latency. Like human varicella-zoster virus
(VZV), SVV causes chicken pox (varicella), becomes latent in ganglia along the
entire neuraxis, and reactivates to produce shingles (zoster). We developed
macroarrays to determine the extent of viral transcription from all 70 predicted 
SVV open reading frames (ORFs) in infected cells in tissue culture. Cloned
fragments (200 to 400 bp) from the 5' and 3' ends of each ORF were PCR amplified,
quantitated, spotted onto nylon membranes, and fixed by UV cross-linking. Using a
cDNA probe prepared from poly(A)+ RNA extracted from SVV-infected Vero cells at
the height of the cytopathic effect (3 days after infection) and
chemiluminescence for detection, transcripts corresponding to all SVV ORFs were
identified. The abundance of each SVV transcript was compared with that
previously demonstrated for VZV in infected tissue culture cells.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15827146 [PubMed - indexed for MEDLINE]

730: Neurology. 2005 Apr 12;64(7):1138.

MRI of segmental zoster paresis.

Samuraki M, Yoshita M, Yamada M.

Publication Types: 
    Case Reports

PMID: 15824336 [PubMed - indexed for MEDLINE]

731: Epidemiol Infect. 2005 Apr;133(2):245-53.

Incidence of herpes zoster, 1997-2002.

Mullooly JP, Riedlinger K, Chun C, Weinmann S, Houston H.

Kaiser Permanente Center for Health Research, Northwest Region, 3800 N.
Interstate Drive, Portland, OR 97227-1098, USA. john.mullooly@kpchr.org

We estimated age-specific herpes zoster (HZ) incidence rates in the Kaiser
Permanente Northwest Health Plan (KPNW) during 1997-2002 and tested for secular
trends and differences between residents of two states with different varicella
vaccine coverage rates. The cumulative proportions of 2-year-olds vaccinated
increased from 35% in 1997 to 85% in 2002 in Oregon, and from 25% in 1997 to 82% 
in 2002 in Washington. Age-specific HZ incidence rates in KPNW during 1997-2002
were compared with published rates in the Harvard Community Health Plan (HCHP)
during 1990-1992. The overall HZ incidence rate in KPNW during 1997-2002
(369/100,000 person-years) was slightly higher than HCHP's 1990-1992 rate when
adjusted for age differences. For children 6-14 years old, KPNW's rates (182 for 
females, 123 for males) were more than three times HCHP's rates (54 for females, 
39 for males). This increase appears to be associated with increased exposure of 
children to oral corticosteroids. The percentage of KPNW children exposed to oral
corticosteroids increased from 2.2% in 1991 to 3.6% in 2002. Oregon residents had
slightly higher steroid exposure rates during 1997-2002 than Washington
residents. There were significant increases in HZ incidence rates in Oregon and
Washington during 1997-2002 among children aged 10-17 years, associated with
increased exposure to oral steroids.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15816149 [PubMed - indexed for MEDLINE]

732: Nat Med. 2005 Apr;11(4 Suppl):S16-9.

The process development challenge for a new vaccine.

Buckland BC.

Merck Research Laboratories, West Point, Pennsylvania 19486, USA.
barry_buckland@merck.com

The challenges of vaccine development are not limited to identification of
suitable antigens, adjuvants and delivery methods, but include regulatory,
technical and manufacturing hurdles in translating a vaccine candidate to the
clinic. Process development is the technological foundation that underlies the
manufacture of new vaccines and is central to successful commercialization.

PMID: 15812483 [PubMed - indexed for MEDLINE]

733: Bone Marrow Transplant. 2005 Jun;35(11):1065-9.

The effect of low-dose aciclovir on reactivation of varicella zoster virus after 
allogeneic haemopoietic stem cell transplantation.

Thomson KJ, Hart DP, Banerjee L, Ward KN, Peggs KS, Mackinnon S.

Department of Haematology, University College London Hospitals, 98 Chenies Mews, 
London WC1E 6HX, UK. kirsty.thomson@uclh.org

Patients undergoing haemopoietic stem cell transplants (HSCT) are at high risk of
varicella zoster virus (VZV) reactivation, with a significant incidence of
dissemination. This study reports a retrospective analysis of 247 allogeneic HSCT
recipients receiving anti-viral prophylaxis with low-dose oral aciclovir 400
mg/day, administered until immunosuppression was discontinued and the CD4(+) cell
count exceeded 200/mm(3). Viral reactivation was successfully suppressed by
aciclovir prophylaxis, with only one case of breakthrough infection. The
cumulative incidence of zoster infection at 1 year post transplant was 2% and at 
5 years 34%. In all, 64 patients discontinued prophylaxis. Zoster developed in 26
of these, giving a cumulative incidence of infection at 1 year after stopping
aciclovir of 39% and at 3 years 44%. Infection occurred in a localised dermatomal
distribution in 93% of cases. This supports previous findings that aciclovir
prophylaxis prevents early VZV reactivation, although the long-term incidence is 
not affected as infection occurs once prophylaxis is discontinued. Such
infection, however, is mild and localised. This study does not support the idea
that use of such low-dose aciclovir regimens reduces the zoster incidence by
permitting subclinical reactivation during prophylaxis, and therefore the
re-establishment of protective anti-viral immunity.

PMID: 15806119 [PubMed - indexed for MEDLINE]

734: Int Ophthalmol Clin. 2005 Spring;45(2):89-97.

Herpetic posterior uveitis.

Zamir E.

Ocular Immunology Service, The Royal Victorian Eye and Ear Hospital, 32 Gisborne 
Street, East Melbourne, Victoria 3002, Australia.

Publication Types: 
    Review

PMID: 15791160 [PubMed - indexed for MEDLINE]

735: Int Ophthalmol Clin. 2005 Spring;45(2):41-55.

Polymerase chain reaction in the diagnosis of uveitis.

Chan CC, Shen D, Tuo J.

Section of Immunopathology, Laboratory of Immunology, National Eye Institute/NIH,
Bldg. 10, Rm. 10N103, 10 Center Drive, Bethesda, MD 20892-1857, USA.

Publication Types: 
    Case Reports
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15791157 [PubMed - indexed for MEDLINE]

736: Br J Dermatol. 2005 Mar;152(3):569-70.

Reactivation of ophthalmic herpes zoster following pulsed-dye laser treatment for
inflammatory acne vulgaris.

Clayton TH, Stables GI.

Publication Types: 
    Case Reports
    Letter

PMID: 15787833 [PubMed - indexed for MEDLINE]

737: Klin Monatsbl Augenheilkd. 2005 Mar;222(3):264-6.

Varicella-zoster virus retinitis: successful evolution with a combination of
antiviral therapies.

Oueghlani E, Baglivo E, Durakovic O, Safran AB.

Clinique d'Ophtalmologie, Hopitaux Universitaires de Geneve, Geneva, Switzerland.

BACKGROUND: We present the description of a successful outcome in a case of
varicella-zoster virus (VZV) acute retinal necrosis (ARN). HISTORY AND SIGNS: A
healthy 40-year-old patient was admitted for a VZV retinitis. THERAPY AND
OUTCOME: 10 days after the onset of intravenous (i. v.) acyclovir treatment, new 
small peripheral retinal necrotic lesions appeared in the right eye. A viral
resistance was suspected and the acyclovir therapy was optimised with i. v.
foscarnet combined with 2 intravitreal injections of ganciclovir. The outcome was
favourable with a final vision of 1.0 after a follow-up of 30 months. No systemic
or local complications were observed. CONCLUSIONS: VZV ARN is a severe infection 
with a poor prognosis. This case demonstrates that combination of antiviral
therapies given intravenously (acyclovir + foscarnet) and in the vitreous
(ganciclovir) may be safe and efficacious in the management of necrotising
herpetic retinopathies affecting immunocompetent patients.

Publication Types: 
    Case Reports

PMID: 15785997 [PubMed - indexed for MEDLINE]

738: Neurology. 2005 Mar 22;64(6):1007.

CNS myelomatosis.

Lupu VD, Saini N, Balish M.

EMG section, National Institute of Neurologic Disorders and Stroke, NIH, Bldg.
10, Room 5C101, 10 Center Drive MSC-1404, Bethesda, MD 20892-1404, USA.
lupuv@ninds.nih.gov

Publication Types: 
    Case Reports

PMID: 15781817 [PubMed - indexed for MEDLINE]

739: J Neurol. 2005 Jun;252(6):677-86. Epub 2005 Mar 23.

Postherpetic neuralgia: topical lidocaine is effective in nociceptor-deprived
skin.

Wasner G, Kleinert A, Binder A, Schattschneider J, Baron R.

Dept. of Neurological Pain Research and Therapy, Neurological Clinic,
Universitatsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10,
24105 Kiel, Germany. g.wasner@neurologie.uni-kiel.de

OBJECTIVES: Topical lidocaine is effective in postherpetic neuralgia (PHN). The
aim of the present investigation was to classify patients according to their
predominant peripheral nociceptor function and to compare these data with the
results of a controlled study using dermal lidocaine patch. METHODS: Within the
skin area of maximal pain QST (thermotest) and QCART (histamine iontophoresis and
laser Doppler flowmetry) were performed prospectively in 18 PHN patients. A
controlled study using cutaneous lidocaine (lidocaine 5% patch, IBSA) followed.
RESULTS: Six patients (group I, sensitised nociceptors) had no sensory loss. Heat
pain thresholds were equal or lower than on the contralateral side.
Histamine-induced flare and axon reflex vasodilatation were not different on both
sides. Histamine evoked pain increased. In 12 patients (group II, nociceptor
impairment) heat pain thresholds were higher than contralateral.
Histamine-induced flare was impaired or abolished. Histamine did not induce any
sensation. Lidocaine was efficacious in the entire group of patients. Subgroup
analysis revealed that patients with impairment of nociceptor function had
significantly greater pain reduction under lidocaine vs placebo. Patients with
preserved and sensitised nociceptors demonstrated no significant pain relief.
CONCLUSIONS: PHN patients differ concerning their cutaneous nociceptor function: 
In the group I pain is caused by pathologically sensitised nociceptors. In subset
II there is a loss of function of cutaneous C-nociceptors within the allodynic
skin. Patients responded well to topical lidocaine even if the skin was
completely deprived of nociceptors. Different underlying mechanisms of lidocaine 
action in nociceptor-deprived skin are discussed.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15778907 [PubMed - indexed for MEDLINE]

740: Eye. 2006 Feb;20(2):247.

Comment on:
    Eye. 2004 May;18(5):544-5.

High dosage of oral valaciclovir as an alternative treatment of varicella zoster 
acute retinal necrosis syndrome.

Guex-Crosier Y, Meylan PR.

Publication Types: 
    Comment
    Letter

PMID: 15776013 [PubMed - indexed for MEDLINE]

741: J Neurol Neurosurg Psychiatry. 2005 Apr;76(4):572.

Post herpetic neuralgia.

Pearce JM.

jmsp@freenet.co.uk

Publication Types: 
    Historical Article

PMID: 15774448 [PubMed - indexed for MEDLINE]

742: Treat Guidel Med Lett. 2005 Apr;3(32):23-32.

Erratum in:
    Treat Guidel Med Lett. 2005 May;3(33):38.

Drugs for non-HIV viral infections.

[No authors listed]

PMID: 15767977 [PubMed - indexed for MEDLINE]

743: Eur J Pediatr. 2005 Jun;164(6):366-70. Epub 2005 Mar 4.

Prospective surveillance of hospitalisations associated with varicella-zoster
virus infections in children and adolescents.

Bonhoeffer J, Baer G, Muehleisen B, Aebi C, Nadal D, Schaad UB, Heininger U.

Division of Paediatric Infectious Diseases, University Children's Hospital, P.O. 
Box, 4005, Basel, Switzerland.

Our goal was to determine the epidemiology of severe varicella-zoster virus (VZV)
infections in hospitalised paediatric patients. Admissions associated with VZV
infection of patients aged 0-16 years were reported by all 38 paediatric units in
Switzerland to the Swiss Paediatric Surveillance Unit (SPSU) during 3 consecutive
years (4/2000-3/2003). We verified completeness of reporting by capture-recapture
analysis with patient records identified by ICD-10 codes. Outcome of illness was 
assessed 6 months after hospitalisation. A total of 335 cases (235 identified by 
SPSU reports, 100 by ICD-10 code) were included in this study. Mean age of
patients was 4.1 years (median 3.5 years, range 0-16 years); 54% were male. Some 
293 (87%) patients presented with chickenpox, 42 (13%) with herpes zoster and 291
(87%) patients were not immunocompromised. A total of 319 complications occurred 
in 237 (71%) patients: secondary bacterial infections (n =109); central nervous
system involvement (n =76); VZV pneumonitis (n =7); others (n =127). Eleven (3%) 
patients required intensive care and three died. On follow-up, 303 (96%) of 315
patients had completely recovered; sequelae were present in 12 (4%) patients. The
calculated hospitalisation rate was 13 per 10(4) cases. CONCLUSION: This study
describes a sizeable hospitalisation and complication rate of varicella-zoster
virus infections and provides a solid basis for future immunisation
recommendations in Switzerland.

PMID: 15747132 [PubMed - indexed for MEDLINE]

744: Acta Neurol Scand. 2005 Apr;111(4):229-32.

Oxcarbazepine monotherapy in postherpetic neuralgia unresponsive to carbamazepine
and gabapentin.

Criscuolo S, Auletta C, Lippi S, Brogi F, Brogi A.

U.O.C. Terapia Antalgica e Terapia Postoperatoria, Azienda Ospedaliera Senese
Policlinico Le Scotte Siena, Italy.

OBJECTIVES: We present the results of a preliminary, open-label trial to evaluate
the efficacy and tolerability of oxcarbazepine in postherpetic neuralgia (PHN)
unresponsive to treatment with antiepileptic drugs (carbamazepine and gabapentin)
and local anesthetic blocks. MATERIALS AND METHODS: Twenty-four patients were
treated with oxcarbazepine monotherapy for 8 weeks. Starting dose was 150 mg/day,
subsequently increased by 150 mg/day every 2 days until a maintenance dose of 900
mg/day. Pain was assessed using a visual analog scale (VAS). RESULTS: There was a
significant decrease in the mean VAS score following 8 weeks of treatment
(Delta=5.33; paired t-test: P <0.0001) compared with baseline. Oxcarbazepine was 
effective from the first week of treatment. There was a significant reduction in 
allodynia, leading to improvements in patients' functioning and quality of life. 
Oxcarbazepine was generally well tolerated. CONCLUSION: Oxcarbazepine appears to 
be a promising alternative monotherapeutic approach for patients affected by PHN.

Publication Types: 
    Clinical Trial

PMID: 15740573 [PubMed - indexed for MEDLINE]

745: Eur J Pain. 2005 Apr;9(2):167-71.

Use of the Rydel-Seiffer graduated tuning fork in the assessment of vibration
threshold in postherpetic neuralgia patients and healthy controls.

Whitton TL, Johnson RW, Lovell AT.

United Bristol Healthcare Trust, Bristol, UK.

BACKGROUND AND AIMS: Afferent large fibre impairment has been reported as a
useful predictor of postherpetic neuralgia (PHN) in patients with acute herpes
zoster infection, using an electromechanical device to provide quantitative
vibrametry. We aimed to demonstrate a clinically significant increase in
vibration threshold in individuals with PHN compared to age-matched controls,
using the portable and affordable Rydel-Seiffer graduated tuning fork. METHODS:
We studied 45 PHN subjects aged over 55 years, and 45 age-matched controls with
no history of herpes zoster infection. We excluded subjects with a history of
disorders associated with neuropathy or immunocompromise. Measurements were
performed at the ulnar styloid process and the head of the first metatarsal on
the right side, in a warm room with the subject seated. Readings were taken in
triplicate and the data analysed by a repeated measures design. RESULTS: We
observed a significant difference in vibration threshold at both wrist and toe
between the PHN and control groups (p < 0.001). Age-stratification of subjects
produced an increased and clinically useful difference between the two groups at 
both sites in subjects between 55 and 70 years (p < 0.0001). CONCLUSIONS: We have
shown a statistically significant decrease in vibration sensitivity in
individuals with PHN aged 55-70 years compared to age-matched healthy controls,
using the Rydel-Seiffer graduated tuning fork. A prospective study of patients
with acute zoster infection is needed to determine the sensitivity and
specificity of the graduated tuning fork in predicting PHN in patients with acute
zoster infection.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15737809 [PubMed - indexed for MEDLINE]