1. J Natl Cancer Inst. 2010 Feb 24. [Epub ahead of print]

Immune-Related and Inflammatory Conditions and Risk of Lymphoplasmacytic Lymphoma
or Waldenstrom Macroglobulinemia.

Kristinsson SY, Koshiol J, Bjorkholm M, Goldin LR, McMaster ML, Turesson I,
Landgren O.

Affiliations of authors: Department of Medicine, Division of Hematology,
Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
(SYK, OL); Genetic Epidemiology Branch, Division of Cancer Epidemiology and
Genetics (JK, LRG, MLM, OL) and Center for Cancer Research (OL), National Cancer 
Institute, National Institutes of Health, Bethesda, MD; Department of Medicine,
Section of Hematology, Malmo University Hospital, Malmo, Sweden (IT).

Background Chronic immune stimulation appears to be associated with
lymphoplasmacytic lymphoma (LPL)-Waldenstrom macroglobulinemia (WM); however,
available information is sparse. We conducted, to our knowledge, the most
comprehensive study to date to evaluate associations between a personal or family
history of many immune-related and/or inflammatory disorders and the subsequent
risk of LPL-WM. Methods We used Swedish population-based registries to identify
2470 case patients with LPL-WM, 9698 matched control subjects, and almost 30 000 
first-degree relatives of either case patients or control subjects. We evaluated 
a wide range of autoimmune, infectious, allergic, and inflammatory conditions. We
calculated odds ratios (ORs) and 95% confidence intervals (CIs) for each
condition by use of logistic regression. Results An increased risk of LPL-WM was 
associated with a personal history of the following autoimmune diseases: systemic
sclerosis (OR = 4.7, 95% CI = 1.4 to 15.3), Sjogren syndrome (OR = 12.1, 95% CI =
3.3 to 45.0), autoimmune hemolytic anemia (OR = 24.2, 95% CI = 5.4 to 108.2),
polymyalgia rheumatica (OR = 2.9, 95% CI = 1.6 to 5.2), and giant cell arteritis 
(OR = 8.3, 95% CI = 2.1 to 33.1). An increased risk of LPL-WM was associated with
a personal history of the following infectious diseases: pneumonia (OR = 1.4, 95%
CI = 1.1 to 1.7), septicemia (OR = 2.4, 95% CI = 1.2 to 4.3), pyelonephritis (OR 
= 1.7, 95% CI = 1.1 to 2.5), sinusitis (OR = 2.7, 95% CI = 1.4 to 4.9), herpes
zoster (OR = 3.4, 95% CI = 2.0 to 5.6), and influenza (OR = 2.9, 95% CI = 1.7 to 
5.0). An increased risk of LPL-WM was associated with a family history of the
following autoimmune or infectious diseases: Sjogren syndrome (OR = 5.0, 95% CI =
2.1 to 12.0), autoimmune hemolytic anemia (OR = 3.8, 95% CI = 1.1 to 13.2),
Guillain-Barre syndrome (OR = 4.1, 95% CI = 1.8 to 9.4), cytomegalovirus (OR =
2.7, 95% CI = 1.4 to 5.3), gingivitis and periodontitis (OR = 1.9, 95% CI = 1.3
to 2.7), and chronic prostatitis (OR = 4.3, 95% CI = 1.7 to 11.1). Conclusions
Personal history of certain immune-related and/or infectious conditions was
strongly associated with increased risk of LPL-WM. The association of both
personal and family history of Sjogren syndrome and autoimmune hemolytic anemia
with risk of LPL-WM indicates the potential for shared susceptibility for these
conditions.

PMID: 20181958 [PubMed - as supplied by publisher]


2. J Clin Virol. 2010 Feb 22. [Epub ahead of print]

Disease burden of herpes zoster in Korea.

Choi WS, Noh JY, Huh JY, Jo YM, Lee J, Song JY, Kim WJ, Cheong HJ.

Division of Infectious Disease, Department of Internal Medicine, Korea University
College of Medicine, Seoul, Republic of Korea.

BACKGROUND: The occurrence of herpes zoster can deteriorate the quality of life
considerably, resulting in high disease burden. While Korea is assumed to have
high disease burden of herpes zoster, there has been no researches analyzing
this. OBJECTIVES: We performed this study to investigate the disease burden of
herpes zoster in the Korean population as a whole. STUDY DESIGN: We used the
database of the Health Insurance Review & Assessment Service of Korea and
analyzed the data of patients who had herpes zoster as a principal diagnosis
during the period from 2003 to 2007. We investigated the annual prevalence, rate 
of clinical visits, rate of hospitalization, and the pattern of medical services 
use. The socioeconomic burden of herpes zoster was calculated by a conversion
into cost. RESULTS: Rates of clinic visits and hospitalizations due to herpes
zoster during the 5-year period from 2003 to 2007 were 7.93-12.54 per 1000
population and 0.22-0.32 per 1000 population, respectively. Prevalence rates
according to age increased sharply after 50 years and reached a peak at 70 years.
The total socioeconomic cost of herpes zoster was $75.9-143.8 million per year,
increasing every year by 14-20%. CONCLUSIONS: There is a heavy socioeconomic
burden due to herpes zoster in Korea and indicate that appropriate policies need 
to be established to reduce this burden. Additional researches are also necessary
to assess the safety, efficacy and cost-effectiveness of a herpes zoster vaccine 
in the Korean population. Copyright © 2010 Elsevier B.V. All rights reserved.

PMID: 20181512 [PubMed - as supplied by publisher]


3. Cases J. 2010 Jan 12;3(1):17. [Epub ahead of print]

An unusual cause of visual loss after Herpes zoster ophthalmicus: a case report.

Camuglia JE, Beltz JE, Khurana K, Hall AJ.

ABSTRACT: INTRODUCTION: The vascular complications of herpes zoster are well
recognised, however, there are few reports of central retinal artery occlusion.
Central retinal artery occlusion following herpes zoster ophthalmicus is poorly
recognised. This is likely due to the difficulties in obtaining tissue for
histopathology to establish causality. We report a case of central retinal artery
occlusion and complete internal carotid artery occlusion following herpes zoster 
ophthalmicus. CASE PRESENTATION: A 44 year old Caucasian female presented with
sudden painless loss of vision in her right eye on a background of chronic
lymphocytic leukaemia and right sided herpes zoster ophthalmicus. She was
initially treated with steroids and antivirals for an underlying presumed
vasculitic cause, but review at 24 hours demonstrated a right central retinal
artery occlusion. Embolic screen identified complete occlusion of the right
internal carotid artery. She was treated with oral antiviral medication for three
weeks but had no visual recovery. CONCLUSION: This case highlights an uncommon
cause of acute visual loss. We propose that the underlying small and large vessel
occlusion in this patient was due to herpes zoster related vasculopathy. A review
of the literature is presented to trace the historical perspective of herpes
zoster related vasculopathy.

PMID: 20180950 [PubMed - as supplied by publisher]


4. Clin Infect Dis. 2010 Feb 23. [Epub ahead of print]

Increasing Incidence of Herpes Zoster among Veterans.

Rimland D, Moanna A.

Atlanta Veterans Affairs Medical Center, Decatur, and 2Emory University School of
Medicine, Atlanta, Georgia.

Background. The incidence of herpes zoster in the United States has been
estimated to be 1 million cases annually, with a higher rate in adults older than
60 years. The morbidity of the disease, including postherpetic neuralgia, imposes
significant effects on quality of life. We analyzed reports of herpes zoster in
the Veterans Affairs (VA) population because these patients are older and could
provide a reflection of disease trends in the aging US population. These data
will provide a baseline for future analyses of the incidence of herpes zoster
after the introduction of the herpes zoster vaccine in late 2007. Methods. To
evaluate the trend in the annual incidence of herpes zoster for fiscal year 2000 
(beginning October 1999) through fiscal year 2007 (through September 2007), we
derived incidence rates using the Veterans Health Administration Decision Support
System reports of herpes zoster by International Classification of Diseases,
Ninth Revision codes from 2000 through 2007 and the corresponding denominator
data for all veterans in care. These rates were validated by review of medical
records of patients with diagnoses of herpes zoster at the Atlanta VA Medical
Center. Results. The annual incidence of herpes zoster increased from 3.10
episodes per 1000 veterans in 2000 to 5.22 in 2007 ([Formula: see text];
[Formula: see text]). This increasing rate was seen in both men and women but
only in groups older than 40 years. Conclusion. The increasing incidence of
herpes zoster in our veteran population and its effect on the quality of life of 
the veterans validate the need for improved rates of vaccination in this
population.

PMID: 20178416 [PubMed - as supplied by publisher]


5. J Clin Oncol. 2010 Feb 22. [Epub ahead of print]

Phase I Study of KW-0761, a Defucosylated Humanized Anti-CCR4 Antibody, in
Relapsed Patients With Adult T-Cell Leukemia-Lymphoma and Peripheral T-Cell
Lymphoma.

Yamamoto K, Utsunomiya A, Tobinai K, Tsukasaki K, Uike N, Uozumi K, Yamaguchi K, 
Yamada Y, Hanada S, Tamura K, Nakamura S, Inagaki H, Ohshima K, Kiyoi H, Ishida
T, Matsushima K, Akinaga S, Ogura M, Tomonaga M, Ueda R.

Department of Hematology and Cell Therapy, Aichi Cancer Center; Department of
Clinical Pathophysiology and Department of Infectious Diseases, Nagoya University
Graduate School of Medicine; Department of Hematology and Oncology, Nagoya Daini 
Red Cross Hospital, Nagoya; Department of Clinical Pathology and Department of
Medical Oncology and Immunology, Nagoya City University Graduate School of
Medical Sciences, Nagaya; Department of Hematology, Imamura Bun-in Hospital;
Department of Internal Medicine, National Hospital Organization Kagoshima Medical
Center; Department of Hematology and Immunology, Kagoshima University Hospital,
Kagoshima; Hematology and Stem Cell Transplantation Division, National Cancer
Center Hospital; Department of Safety Research on Blood and Biologics, National
Institute of Infectious Diseases; Department of Molecular Preventive Medicine,
Graduate School of Medicine, The University of Tokyo; Kyowa Hakko Kirin Co Ltd,
Tokyo; Department of Hematology and Molecular Medicine Unit and Department of
Laboratory Medicine, Nagasaki University Graduate School of Biomedical Science,
Nagasaki; Department of Hematology, National Kyushu Cancer Center; The Department
of Medicine, Division of Medical Oncology, Infectious Disease, and Endocrinology,
School of Medicine, Fukuoka University, Fukuoka; and the Department of
Pathophysiology, Kurume University School of Medicine, Kurume, Japan.

PURPOSE: KW-0761, a defucosylated humanized anti-CC chemokine receptor 4 (CCR4)
antibody, exerts a strong antibody-dependent cellular cytotoxic effect. This
phase I study assessed the safety, pharmacokinetics, recommended phase II dose
and efficacy of KW-0761 in patients with relapsed CCR4-positive adult T-cell
leukemia-lymphoma (ATL) or peripheral T-cell lymphoma (PTCL). PATIENTS AND
METHODS: Sixteen patients received KW-0761 once a week for 4 weeks by intravenous
infusion. Doses were escalated, starting at 0.01, 0.1, 0.5, and finally 1.0 mg/kg
by a 3 + 3 design. RESULTS: Fifteen patients completed the protocol treatment.
Only one patient, at the 1.0 mg/kg dose, developed grade 3 dose-limiting
toxicities, skin rash, and febrile neutropenia, and grade 4 neutropenia. Other
treatment-related grade 3 to 4 toxicities were lymphopenia (n = 10), neutropenia 
(n = 3), leukopenia (n = 2), herpes zoster (n = 1), and acute infusion
reaction/cytokine release syndrome (n = 1). Neither the frequency nor severity of
toxicities increased with dose escalation. The maximum tolerated dose was not
reached. Therefore, the recommended phase II dose was determined to be 1.0 mg/kg.
No patients had detectable levels of anti-KW-0761 antibody. The plasma maximum
and trough, and the area under the curve of 0 to 7 days of KW-0761, tended to
increase dose and frequency dependently. Five patients (31%; 95% CI, 11% to 59%) 
achieved objective responses: two complete (0.1; 1.0 mg/kg) and three partial
(0.01; 2 at 1.0 mg/kg) responses. CONCLUSION: KW-0761 was tolerated at all the
dose levels tested, demonstrating potential efficacy against relapsed
CCR4-positive ATL or PTCL. Subsequent phase II studies at the 1.0 mg/kg dose are 
thus warranted.

PMID: 20177026 [PubMed - as supplied by publisher]


6. Aliment Pharmacol Ther. 2010 Feb 18. [Epub ahead of print]

Infliximab as rescue medication for patients with severe ulcerative/indeterminate
colitis refractory to tacrolimus.

Herrlinger KR, Barthel DN, Schmidt KJ, Buning J, Barthel CS, Wehkamp J, Stange
EF, Fellermann K.

Department of Gastroenterology, Hepatology and Endocrinology,
Robert-Bosch-Hospital, Stuttgart, Germany.

SUMMARY Background: The calcineurin inhibitor tacrolimus and the
anti-TNF-antibody infliximab are established options in steroid refractory
ulcerative colitis (UC). The aim of this study was to determine the efficacy of
infliximab as rescue medication in patients failing to respond to tacrolimus.
Aim: To evaluate the efficacy of infliximab-salvage therapy in patients with
refractory ulcerative colitis failing to respond to tacrolimus Methods:
Twenty-four patients were enrolled in this evaluation. Reasons for tacrolimus
therapy were steroid-refractory disease in 19 patients and steroid dependency in 
5 patients. All patients receiving infliximab had tacrolimus refractory active
disease (Lichtiger score >10) and were treated with 5mg/kg at weeks 0, 2 and 6
and every 8 weeks thereafter if tolerated. Results: Six of 24 patients (25%)
achieved remission following infliximab infusion and 4/24 (17%) had an initial
response only but underwent proctocolectomy later due to loss of response (3) or 
development of a delayed hypersensitivity reaction (1). Fourteen patients (58%)
completely failed to respond with 10 undergoing colectomy. Eight patients
experienced side effects under infliximab including two infectious complications 
(herpes zoster and herpes pneumonia). Conclusions: Infliximab offers a
therapeutic option as rescue therapy in about a quarter of patients with active
UC after failing to respond to tacrolimus. This benefit has to be weighed against
the risks of infectious complications.

PMID: 20175769 [PubMed - as supplied by publisher]


7. J Pharmacol Sci. 2010 Feb 20. [Epub ahead of print]

Blockade of Glycine Transporter (GlyT) 2, but Not GlyT1, Ameliorates Dynamic and 
Static Mechanical Allodynia in Mice With Herpetic or Postherpetic Pain.

Nishikawa Y, Sasaki A, Kuraishi Y.

Department of Applied Pharmacology, Graduate School of Medicine and
Pharmaceutical Sciences, University of Toyama, Japan.

Glycine is an inhibitory neurotransmitter in the spinal dorsal horn and its
extracellular concentration is regulated by glial glycine transporter (GlyT) 1
and neuronal GlyT2. This study was conducted to elucidate the effects of
intrathecal injections of GlyT1 and GlyT2 inhibitors on two distinct types of
mechanical allodynia, dynamic and static allodynia, in mice with herpetic or
postherpetic pain. The GlyT2 inhibitor ALX1393, but not the GlyT1 inhibitor
sarcosine, suppressed dynamic and static allodynia at the herpetic and
postherpetic stages. Intrathecal ALX1393 suppressed dynamic allodynia induced by 
intrathecal strychnine and N-methyl-D-aspartate (NMDA). Intrathecal sarcosine
suppressed dynamic allodynia induced by intrathecal strychnine, but not NMDA.
Expression level of GlyT1, but not GlyT2, mRNA in the lumbar dorsal horn was
decreased at the herpetic and postherpetic stages. Glycine receptor
alpha1-subunit mRNA was decreased in the lumbar dorsal horn at the herpetic, but 
not postherpetic stage, without alteration in alpha3-subunit mRNA. The results
suggest that GlyT2 is a potential target for treatment of dynamic and static
allodynia in patients with herpes zoster and postherpetic neuralgia. The lack of 
efficacy of GlyT1 inhibitor may be explained by activation of NMDA receptors and 
the down-regulation of GlyT1 in the lumbar dorsal horn.

PMID: 20173309 [PubMed - as supplied by publisher]


8. J Virol Methods. 2010 Feb 17. [Epub ahead of print]

The glycoproteins C and G are equivalent target antigens for the determination of
herpes simplex virus type 1-specific antibodies.

Scheper T, Saschenbrecker S, Steinhagen K, Sauerbrei A, Suer W, Meyer W,
Schlumberger W, Wandinger KP.

Institute of Experimental Immunology, affiliated to EUROIMMUN AG, Seekamp 31,
D-23560 Luebeck, Germany; These authors contributed equally to this work.

Seroreactivity to the glycoproteins C and G of herpes simplex virus type 1
(HSV-1) was compared in 310 serum samples using a Western blot assay containing a
whole antigen extract of HSV-1 and an ELISA employing gC1 isolated from HSV-1.
The prevalence of reactivity to gC1 was 75.8% by Western blot and 73.9% by ELISA,
while antibody responses to gG1 were detected in 72.9% of sera by Western blot.
An absolute correlation of 96.1% between the reactivity to gC1 and gG1 was
demonstrated using the Western blot. The gC1-based ELISA correlated with Western 
blot detection of anti-gC1 and anti-gG1 antibodies in 95.2% and 97.7% of samples,
respectively. 3.2% of all sera were reactive with gC1 in Western blot and/or
ELISA, but were negative for anti-gG1. For analysis of cross-reactivity,
antibodies against HSV-2, Epstein-Barr virus, varicella-zoster virus and
cytomegalovirus were determined. The prevalence of antibodies against each
individual virus was identical in the groups of sera reactive with gC1 or gG1.
These findings indicate that gC1 and gG1 are equivalent antigenic targets for the
type-specific serodiagnosis of HSV-1 infections. Copyright © 2010. Published by
Elsevier B.V.

PMID: 20171247 [PubMed - as supplied by publisher]


9. Hautarzt. 2010 Feb 19. [Epub ahead of print]

[Skin infections after transplantation.]

[Article in German]

Wolf IH.

Universitatsklinik fur Dermatologie und Venerologie, Abteilung fur Allgemeine
Dermatologie, Medizinische Universitat Graz, Auenbruggerplatz 8, 8036, Graz,
Osterreich, ingrid.wolf@medunigraz.at.

Skin infections after transplantation are frequent and of special importance
because they may be quite severe. The spectrum of dermatologic infections in
transplant recipients includes bacterial, mycotic and viral diseases. Pyoderma,
herpes virus 6/7, herpes simplex virus, varicella-zoster virus, cytomegalovirus
and candida infections predominate. Rare pathogens must be also considered.
Cutaneous infections can be divided into three phases following transplantation. 
Diagnosis and adequate early therapy together with specific prophylaxis and
follow-up of transplant patients should be strived for to avoid life-threatening 
complications.

PMID: 20165826 [PubMed - as supplied by publisher]


10. Arch Phys Med Rehabil. 2010 Feb;91(2):321-5.

Herpes zoster-induced trunk muscle paresis presenting with abdominal wall
pseudohernia, scoliosis, and gait disturbance and its rehabilitation: a case
report.

Tashiro S, Akaboshi K, Kobayashi Y, Mori T, Nagata M, Liu M.

Department of Rehabilitation Medicine, Ichikawa City Rehabilitation Hospital,
Ichikawa City, Japan. s-tashiro@umin.net

Herpes zoster (HZ)-induced abdominal wall pseudohernia has been frequently
reported, but there has been no report describing HZ-induced trunk muscle paresis
leading to functional problems. We describe a 73-year-old man with T12 and L1
segmental paresis caused by HZ presenting with abdominal wall pseudohernia,
scoliosis, and standing and gait disturbance who responded well to a systematic
rehabilitation approach. He first noticed a right abdominal bulge in the 6th
postherpetic week, which was gradually accompanied by right convex thoracolumbar 
scoliosis, pain, and standing and gait disturbance in the 12th week. Needle
electromyography revealed abnormal spontaneous activities at rest in the right
T12 myotomal muscles, and motor unit recruitment was markedly decreased. We
arranged an outpatient rehabilitation program consisting of using a soft
thoracolumbosacral orthosis for pain relief and trunk stability, muscle
reeducation of the paretic abdominal muscles, strengthening of the disused trunk 
and extremity muscles, and gait exercise. Based on electromyographic findings, we
instructed him in an effective method of muscle reeducation. After 4 months of
rehabilitation, he showed marked improvement and became an outdoor ambulator. We 
suggest that electromyography is a useful tool to evaluate clinical status and
devise an effective rehabilitation program in patients with HZ trunk paresis.
Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

PMID: 20159140 [PubMed - in process]


11. J Neurol. 2010 Feb 13. [Epub ahead of print]

Trigeminal herpes zoster and Ramsay Hunt Syndrome with a lesion in the spinal
trigeminal nucleus and tract.

Hung CW, Wang SJ, Chen SP, Lirng JF, Fuh JL.

Department of Neurology, Yangming Branch, Taipei City Hospital, Taipei, Taiwan,
ROC.

We report the case of a 77-year-old immuno-competent man who developed herpes
zoster in the maxillary and mandibular branches of the trigeminal nerve. Within 3
weeks, he developed ipsilateral peripheral facial palsy, hearing loss, vesicles
over the external auditory canal, and pain in the face and ear. A T(2)-weighted
MRI of the brain revealed a hyper-intense lesion at the right medulla
corresponding to the spinal trigeminal nucleus and tract. Gadolinium enhancement 
was seen over the right facial nerve. These lesions suggest a possibility of
transaxonal spread of the varicella zoster virus between the trigeminal nerve,
the facial nerve, and the spinal trigeminal nucleus and tract.

PMID: 20155276 [PubMed - as supplied by publisher]


12. Nat Rev Rheumatol. 2010 Feb 9. [Epub ahead of print]

Tumor necrosis factor blockade and the risk of viral infection.

Kim SY, Solomon DH.

Division of Rheumatology, Immunology, and Allergy, and Division of
Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 75
Francis Street, Boston, MA 02115, USA.

Tumor necrosis factor (TNF) blockers are widely used to treat rheumatoid
arthritis and other chronic inflammatory diseases. Many studies have demonstrated
an increased risk of opportunistic infections such as tuberculosis and fungal
infection in patients treated with TNF blockers, which is thought to be related
to the primary role of TNF both in host defense and in the immune response.
Little is known, however, about the association between TNF blockade and the
development of viral infection. Owing to the critical role of TNF in the control 
of viral infection, depletion of this cytokine with TNF blockers could facilitate
the development or reactivation of viral infection. A number of large
observational studies have found an increased risk of herpes zoster in patients
receiving TNF blockers for the treatment of rheumatoid arthritis. This Review
draws attention to the risk of several viral infections, including HIV, varicella
zoster virus, Epstein-Barr virus, cytomegalovirus, and human papillomavirus, in
patients receiving TNF-blocking therapy for chronic inflammatory conditions. In
addition, implications for clinical practice and possible preventative approaches
are discussed.

PMID: 20142812 [PubMed - as supplied by publisher]


13. Proc Natl Acad Sci U S A. 2010 Feb 9;107(6):2461-6. Epub 2010 Jan 21.

Transcriptional coactivator HCF-1 couples the histone chaperone Asf1b to HSV-1
DNA replication components.

Peng H, Nogueira ML, Vogel JL, Kristie TM.

Laboratory of Viral Diseases, National Institute of Allergy and Infectious
Diseases, National Institutes of Health, Bld 4-131, 4 Center Drive, Bethesda, MD 
20892, USA.

The cellular transcriptional coactivator HCF-1 interacts with numerous
transcription factors as well as other coactivators and is a component of
multiple chromatin modulation complexes. The protein is essential for the
expression of the immediate early genes of both herpes simplex virus (HSV) and
varicella zoster virus and functions, in part, by coupling chromatin modification
components including the Set1 or MLL1 histone methyltransferases and the histone 
demethylase LSD1 to promote the installation of positive chromatin marks and the 
activation of viral immediately early gene transcription. Although studies have
investigated the role of HCF-1 in both cellular and viral transcription, little
is known about other processes that the protein may be involved in. Here we
demonstrate that HCF-1 localizes to sites of HSV replication late in infection.
HCF-1 interacts directly and simultaneously with both HSV DNA replication
proteins and the cellular histone chaperone Asf1b, a protein that regulates the
progression of cellular DNA replication forks via chromatin reorganization. Asf1b
localizes with HCF-1 in viral replication foci and depletion of Asf1b results in 
significantly reduced viral DNA accumulation. The results support a model in
which the transcriptional coactivator HCF-1 is a component of the HSV DNA
replication assembly and promotes viral DNA replication by coupling Asf1b to DNA 
replication components. This coupling provides a novel function for HCF-1 and
insights into the mechanisms of modulating chromatin during DNA replication.

PMID: 20133788 [PubMed - in process]


14. J Virol. 2010 Feb 3. [Epub ahead of print]

Impact of varicella zoster virus on dendritic cell subsets in human skin during
natural infection.

Huch JH, Cunningham AL, Arvin AM, Nasr N, Santegoets SJ, Slobedman E, Slobedman
B, Abendroth A.

Department of Infectious Diseases and Immunology, University of Sydney, New South
Wales 2006, Australia; Centre For Virus Research, Westmead Millennium Institute
and University of Sydney, Westmead, New South Wales 2145, Australia; Departments 
of Pediatrics and Microbiology and Immunology, Stanford University School of
Medicine, Stanford, CA 94305, USA; Department of Pathology, VU University Medical
Center, De Boelelaan 1117, Amsterdam 1081HV, The Netherlands; Laverty Pathology, 
North Ryde, New South Wales, 2113, Australia.

Varicella zoster virus (VZV) causes varicella and herpes zoster, diseases
characterized by distinct cutaneous rashes. DC are essential for inducing
anti-viral immune responses, however the contribution of DC subsets to the immune
control during natural cutaneous VZV infection has not been investigated.
Immunostaining showed that compared to normal skin, the proportion of cells
expressing DC-SIGN (dermal DC marker) or DC-LAMP and CD83 (mature DC markers)
were not significantly altered in infected skin. In contrast, the frequency of
Langerhans cells was significantly decreased in VZV infected skin, whereas there 
was an influx of plasmacytoid DC, a potent secretor of type I IFN. Langerhans
cells and plasmacytoid DC in infected skin were closely associated with VZV
antigen positive cells, and some Langerhans cells and plasmacytoid DC were VZV
antigen positive. To extend these in vivo observations, both plasmacytoid DC
(PDC) isolated from human blood and Langerhans cells derived from MUTZ-3 cells
were shown to be permissive to VZV infection. In VZV infected PDC cultures
significant induction of IFN-alpha did not occur, indicating the VZV inhibits the
capacity of PDC to induce expression of this host defense cytokine. This study
defines changes in the response of DC which occur during cutaneous VZV infection,
and implicates infection of DC subtypes in VZV pathogenesis.

PMID: 20130046 [PubMed - as supplied by publisher]


15. Sleep Med. 2010 Feb 1. [Epub ahead of print]

A case of reversible restless legs syndrome (RLS) and sleep-related eating
disorder relapse triggered by acute right leg herpes zoster infection: Literature
review of spinal cord and peripheral nervous system contributions to RLS.

Mahowald MW, Cramer Bornemann MA, Schenck CH.

Minnesota Regional Sleep Disorders Center, Department of Neurology, Hennepin
County Medical Center, The University of Minnesota Medical School, Minneapolis,
MN, USA.

Restless legs syndrome (RLS) is thought to be due to abnormalities of iron
metabolism in the central nervous system; however, occasional cases are
associated with lesions of the spinal cord, spinal rootlets, and peripheral
nervous system. This is a case report of RLS exacerbated by shingles with a
review of the literature of extra-cerebral lesions or disorders causing or
contributing to RLS. Copyright © 2010 Elsevier B.V. All rights reserved.

PMID: 20129821 [PubMed - as supplied by publisher]


16. New Microbiol. 2009 Oct;32(4):333-40.

Diagnosis of neurological herpesvirus infections: real time PCR in cerebral
spinal fluid analysis.

Gaeta A, Verzaro S, Cristina LM, Mancini C, Nazzari C.

Clinical Microbiology Department of Science and Public Health, Sapienza
University of Rome, Italy. aurelia.gaeta@uniroma1.it

Human herpesviruses (HHVs) cause many serious acute and persistent central
nervous system (CNS) disorders. Because these infections manifest with various,
often non-specific, symptoms and signs, and because specific therapy is often
available, accurate diagnosis is essential. Cerebrospinal fluid (CSF) from 146
patients with acute meningitis or meningoencephalitis and 9 with "other
neurological disorders" were analyzed by using an automatic system for nucleic
acid extraction and quantitative real-time polymerase chain reaction (PCR) for
herpes simplex 1 and 2 (HSV-1, HSV-2), Epstein-Barr virus (EBV), human
cytomegalovirus (HCMV), herpesvirus-6 (HHV-6), and varicella-zoster virus (VZV). 
HHVs DNA was detected in 52 of 155 (33.5%) analyzed samples. In 39 CSF samples
from patients with meningoencephalitis we found: VZV in 13, HSV-1 in 12, EBV in
6, HHV-6 in 4, and HSV-2 in 4. Co-infections of EBV and HSV-2, HSV-1 and HSV-2,
HSV-1 and VZV were also disclosed in four cases. In addition, two patients with
Guillain-Barre syndrome had HCMV and one showed HHV6 positivity, two patients
with myelitis / polymyeloradiculitis had VZV and HCMV respectively, HHV-6 DNA was
found in one patient with lateral amyotrophic sclerosis. Three CSF specimens from
HIV-infected patients with CNS complications had HHV-6 or EBV DNA. Moreover
quantitative data were also correlated to clinical conditions to obtain more
information on the virus aetiopathogenic role.

PMID: 20128439 [PubMed - in process]


17. Agri. 2009 Oct;21(4):175-7.

[Herpes radiculopathy case presenting first with motor involvement]

[Article in Turkish]

Cinar SM, Bilge S, Hiz F, Erkutlu L.

Department of Neurology, Taksim Training and Research Hospital, Istanbul, Turkey.
mercinar@hotmail.com

Herpes zoster primarily affects the posterior root ganglions and sensorial nerve 
fibers, and causes vesicular skin eruptions, radicular pain and loss of sensorial
function along the distribution of the affected ganglion. Motor involvement can
also be observed. When classical cutaneous lesions are present, the motor paresis
consequent to herpes zoster is easily diagnosed. However, diagnosis becomes
complicated when the motor weakness is the earlier sign and precedes the
cutaneous lesions and sensory symptoms. We present a case in whom the major
clinical symptom and sign was the motor weakness in cervical radiculopathy
consequent to herpes zoster.

PMID: 20127539 [PubMed - in process]


18. J Neurol. 2010 Feb 3. [Epub ahead of print]

The clinical course of idiopathic acute transverse myelitis in patients from Rio 
de Janeiro.

Alvarenga MP, Thuler LC, Neto SP, Vasconcelos CC, Camargo SG, Alvarenga MP,
Papais-Alvarenga RM.

Departamento de Neurologia, Universidade Federal do Estado do Rio de Janeiro, Rua
Mariz e Barros 775, Tijuca, Rio de Janeiro, 20270-004, Brazil,
alvarenga_marina@hotmail.com.

The aim of this study was to describe the demographic, clinical and laboratory
features of idiopathic acute transverse myelitis (IATM). Patients with
non-compressive ATM receiving care at Hospital da Lagoa, Rio de Janeiro (Brazil) 
between 2000 and 2008 were selected. Of the 70 cases of acute myelopathies, the
idiopathic form was identified in 41 following exclusion of the cases associated 
with systemic lupus erythematosus (n = 1), Sjogren's syndrome (n = 1), herpes
zoster (n = 1), cytomegalovirus in an HIV-positive patient (n = 1), Schistosoma
mansoni (n = 1), actinic myelitis (n = 1), infectious myelitis of unknown
etiology (n = 2) and those that, following the first attack of myelitis,
converted to NMO (n = 19) or to clinically defined MS (n = 2). Of the 41 cases of
IATM, the majority of patients were female (68.3%) and white (65.9%). Median age 
at first myelitis was 37.0 +/- 11.8 years. Over a median observation time of 36
months, 39.0% of patients remained monophasic, while recurrences occurred in
61.0% of cases. The number of ATM/patient ranged from one to seven. Among the
recurrent cases the median time between the first and the second ATM was 12
months (range 1-150 months).The first myelitis was characterized mainly by
partial myelitis with motor and sensorial dysfunction (63.4%). Complete and
severe myelitis occurred more frequently among monophasic patients and partial
myelitis with moderate dysfunction at onset in recurrent cases; however, over the
long-term, dysfunction and disability were mild in both groups. Serial spine MRI 
confirmed spinal cord inflammation in 92.0% of cases and extensive spinal cord
lesion was identified in 61.0%. Brain MRI was normal or not suggestive of MS in
94.4% of cases. CSF showed pleocytosis in 41.2%, increased IgG index in 24.0% and
oligoclonal bands in 38.0% of 34 patients tested. Abnormal visual evoked
potentials occurred in 11.5% of 26 patients. Positivity for anti-AQP4 was found
in 23.5% of the 17 cases tested, suggesting limited forms of NMO. This study
suggests some new aspects of the clinical course of IATM such as the high
conversion rate to NMO, the predominance of women and a higher frequency of
recurrent forms.

PMID: 20127351 [PubMed - as supplied by publisher]


19. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Feb;109(2):232-7.

Low prevalence of varicella zoster virus and herpes simplex virus type 2 in
saliva from human immunodeficiency virus-infected persons in the era of highly
active antiretroviral therapy.

Wang CC, Yepes LC, Danaher RJ, Berger JR, Mootoor Y, Kryscio RJ, Miller CS.

Department of Oral Health Practice, University of Kentucky College of Medicine
and College of Dentistry, Lexington, Kentucky 40536-0297, USA.
george.sandor@utoronto.ca

OBJECTIVES: Human herpesviruses, e.g., herpes simplex virus (HSV) type 1,
Epstein-Barr virus, and cytomegalovirus, appear in saliva at greater frequency in
persons infected with human immunodeficiency virus (HIV) than in healthy
individuals. However, it is not known if varicella zoster virus (VZV) and HSV-2
appear simultaneously during HIV infection at greater frequency in saliva in this
era of highly active antiretroviral therapy (HAART). The aim of this study was to
investigate the prevalence and amounts of VZV and HSV-2 in the saliva of
HIV-infected orally asymptomatic patients. STUDY DESIGN: Quantitative polymerase 
chain reaction was used to investigate the prevalence, quantity, risk, and
correlations of salivary VZV and HSV-2 from 59 HIV-seropositive individuals and
53 healthy control subjects in a case-control cross-sectional study.
Seventy-eight percent of the HIV-seropositive patients (46 out of 59) were taking
HAART. RESULTS: VZV DNA was detected in the saliva of 5.1% (3 out of 59) of the
HIV-positive group and in only 1 healthy control 1.9% (1 out of 53; P = .62). The
amount of VZV DNA in the expressors was low, generally <1,100 copies/mL, with no 
observed difference between the HIV-positive group and the control subjects (P = 
1.0). HSV-2 DNA was not detected in either group. In the HIV-infected group, VZV 
shedding occurred in those on HAART, but was not associated with oral lesions,
specific CD4(+) or CD8(+) T-cell levels, or demographic factors. CONCLUSIONS:
Varicella zoster virus was detected at low prevalence in the saliva of
HIV-infected persons, whereas HSV-2 was not detected in the saliva of this
cohort. HAART does not appear to diminish the risk for asymptomatic VZV shedding.
Copyright (c) 2010 Mosby, Inc. All rights reserved.

PMCID: PMC2818125 [Available on 2011/2/1]
PMID: 20123407 [PubMed - in process]


20. Acta Neurol Belg. 2009 Dec;109(4):277-82.

Broad screening for human herpesviridae DNA in multiple sclerosis cerebrospinal
fluid and serum.

Franciotta D, Bestetti A, Sala S, Perucca P, Jarius S, Price RW, Di Stefano AL,
Cinque P.

Laboratory of Neuroimmunology, IRCCS, Foundation "Neurological Institute C.
Mondino", Pavia, Italy. diego.franciotta@mondino.it

Members of the human herpesviridae family are candidates for representing the
macroenvironmental factors associated with multiple sclerosis (MS) pathogenesis. 
Real-time PCR was used to search for DNA of herpes simplex virus type-1/-2,
varicella-zoster virus, cytomegalovirus, Epstein-Barr virus (EBV), human
herpesvirus 6 type A/B in paired cerebrospinal fluid (CSF) and serum samples from
54 patients with MS, 34 of whom with active disease, 10 patients with other
non-infectious neurological diseases, and 15 healthy individuals. All the CSF and
serum samples were negative for the examined herpesviruses DNA, except one CSF
sample from an MS patient, which was positive for EBV DNA. These findings do not 
support a role for the here-studied herpesviruses replication, whether in
systemic or in the intrathecal compartment, as co-pathogenetic factors, nor as
inducers of relapses, in MS.

PMID: 20120207 [PubMed - in process]


21. Mayo Clin Proc. 2010 Feb;85(2):172-5.

Clinical pearls in infectious diseases.

Orenstein R, Litin SC.

Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA.
orenstein.robert@mayo.edu

PMCID: PMC2813826 [Available on 2010/8/1]
PMID: 20118393 [PubMed - indexed for MEDLINE]


22. Ann Emerg Med. 2010 Feb;55(2):A15-7.

A $9,000 bill to diagnose shingles? Doctor's ED visit highlights cost of care
issues.

Berger E.

PMID: 20116023 [PubMed - indexed for MEDLINE]


23. Expert Opin Biol Ther. 2010 Jan 31. [Epub ahead of print]

Shingles vaccine.

Willison CB, Morrison LK, Mendoza N, Tyring SK.

451 North Texas Avenue, Webster, Texas 77598, USA +1 281 333 2288 ext 1109 ; +1
281 335 4605 ; bwillison@ccstexas.com.

Importance of the field: Herpes zoster or shingles is a condition with the
potential to result in severe debilitation. It affects approximately 10 - 30% of 
the population. Until recently there were only treatments to shorten the duration
and lessen the symptoms of herpes zoster, but no practical or approved method of 
prevention for susceptible immunocompetent adults. The live attenuated zoster
vaccine (Zostavax((R)), Merck & Co., Inc.) is effective in preventing shingles in
individuals 60 years of age and older and recommended by the Center for Disease
Control's (CDC) Advisory Committee for Immunization Practices (ACIP). Areas
covered in this review: Literature related to the live attenuated zoster vaccine 
is reviewed from its beginnings in the early 1970s through to the present. What
the reader will gain: Background information on herpes zoster and up to date
information on the live attenuated zoster vaccine including pharmacology,
efficacy and safety are covered. New areas of research in zoster vaccination are 
also discussed. Take home message: The live attenuated zoster vaccine is an
effective and well-tolerated method of preventing zoster and the potentially
debilitating sequelae and is recommended for immunocompetent patients 60 years of
age and older. Ongoing clinical trials are investigating new means of effective
prevention.

PMID: 20113211 [PubMed - as supplied by publisher]


24. Brain Nerve. 2010 Jan;62(1):81-4.

[Herpes zoster oticus-associated jugular foramen syndrome]

[Article in Japanese]

Ono N, Sakabe A, Nakajima M.

Department of Neurology, Tokyo Rosai Occupational Disease and Injuries Hospital, 
Japan.

We report a patient with herpes zoster oticus who presented with acute jugular
foramen syndrome, and we present the review of 9 similar cases reported
previously. Jugular foramen syndrome associated with varicella-zoster virus (VZV)
infection is characterized by acute-onset dysphagia and dysphonia, usually
accompanied or preceded by cranial, cervical, or pharyngeal pain. Herpetic
eruptions on the skin or the mucosal surface may not occur, occur late after
onset, or go undetected. Magnetic resonance imaging may reveal contrast
enhancement around the jugular foramen, which implying inflammation of the
glossopharyngeal or the vagal nerve ganglia, and its extension to the spinal root
of the accessory nerve through the cerebrospinal fluid (CSF). The presence of
VZV-DNA or VZV antibody in the CSF should be tested for early diagnosis and
initiation of anti-viral treatment.

PMID: 20112795 [PubMed - in process]


25. Rev Esp Salud Publica. 2009 Sep-Oct;83(5):711-24.

[Epidemiology of varicella in spain pre-and post-vaccination periods]

[Article in Spanish]

Pena-Rey I, Martinez de Aragon MV, Villaverde Hueso A, Terres Arellano M, Alcalde
Cabero E, Suarez Rodriguez B.

Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Espana. 
sabela@isciii.es

BACKGROUND: Varicella virus can cause two different diseases: chickenpox and
herpes zoster. In 2005 varicella vaccine has been introduced in the Spanish
national vaccination schedule for 10-14 years old non-immune people, in order to 
reduce the severity of the disease. In 2007 a new surveillance protocol with
aggregate data for chickenpox and herpes zoster was approved in order to detect
any change in age distribution, severity and complications of the chickenpox and 
herpes zoster cases. The aim of this study is to know the burden of diseases (in 
the last ten years). METHODS: Number of cases, hospitalization and incidence for 
chickenpox and herpes zoster were study for two periods 1997-2003 and 2005-2007. 
Analysis for 1996-2007 fatal cases was done too. We decided to remove year 2004
because the extremely high chickenpox incidence registered. Sources of data:
RENAVE (Spanish Surveillance Network), Spanish hospital surveillance system
(CMBD), and mortality registries. RESULTS: Chickenpox incidence decreased since
2005, but an increasing trend was detected in hospitalisation with an average of 
1,311 hospitalizations every year. For the 32%-36% of hospitalized cases, the
main diagnosis was not chickenpox. 4-14 deaths per year have been detected; 80%
of them were older than 14 years. Annual rate of herpes zoster hospitalization
was 2.5 per 100,000 inhabitants, similar in both sexes. Case fatality rate per
year was 0.31 per million inhabitants. No significant changes were detected in
age and sex in complicated cases between the two periods. 88% of chickenpox cases
were younger than 15 years old and 64% of herpes zoster older than 50 years in
2007. CONCLUSIONS: Chickenpox has been decreasing during 2005-2007 in Spain. The 
impact of vaccination is difficult to asses, because of a peak registered in 2004
but also because the lack of vaccination coverage information for this period and
the case-data information is available only for the last year.

PMID: 20111819 [PubMed - in process]


26. Lancet. 2010 Jan 16;375(9710):252.

An innocent gallbladder?

Mumoli N, Cei M, Orlandi F, Luschi R, Niccoli G.

Department of Internal Medicine, Ospedale Civile Livorno, Livorno, Italy.
nimumoli@tiscali.it

PMID: 20109926 [PubMed - indexed for MEDLINE]


27. Postgrad Med. 2010 Jan;122(1):91-107.

Treatment of the localized pain of postherpetic neuralgia.

Paster Z, Morris CM.

University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
zpaster@facstaff.wisc.edu

Postherpetic neuralgia (PHN) is a neuropathic pain condition that can arise as a 
complication following herpes zoster infection, with pain often localized to the 
affected dermatome. Patients are initially likely to seek treatment for PHN pain 
from their primary care practitioner; however, adequate pain relief is difficult 
to achieve in many patients. Combination therapies are often used and have shown 
promise, but there is still limited clinical evidence in the literature to
support them. This article reviews the recent literature and guidelines on PHN
treatment, with a focus on combination therapies, and seeks to help primary
health care practitioners select treatment strategies that provide immediate
relief for patients with localized PHN pain.

PMID: 20107293 [PubMed - indexed for MEDLINE]


28. J Virol. 2010 Jan 27. [Epub ahead of print]

Comparison of the biological and biochemical activities of several members of the
alphaherpesvirus ICP0 family of proteins.

Everett RD, Boutell C, McNair C, Grant L, Orr A.

MRC Virology Unit, Institute of Virology, Church Street, Glasgow G11 5JR,
Scotland, U.K.

Immediate-Early protein ICP0 of herpes simplex virus type 1 (HSV-1) is an E3
ubiquitin ligase of the RING finger class that is required for efficient lytic
infection and reactivation from latency. Other alphaherpesviruses also express
ICP0-related RING finger proteins, but these have limited homology outside of the
core RING domain. Existing evidence indicates that ICP0 family members have
similar properties, but there has been no systematic comparison of the
biochemical activities and biological functions of these proteins. Here we
describe an inducible cell line system that allows expression of the ICP0 related
proteins of bovine herpes virus type 1 (BHV-1), equine herpesvirus type 1
(EHV-1), pseudorabies virus (PRV) and varicella zoster virus (VZV) and their
subsequent functional analysis. We report that the RING domains of all the
proteins have E3 ubiquitin ligase activity in vitro. The BHV-1, EHV-1 and PRV
proteins complement ICP0-null mutant HSV-1 plaque formation and induce
de-repression of quiescent HSV-1 genomes to extents similar to those achieved by 
ICP0 itself. VICP0 was found to be extremely unstable, which limited its analysis
in this system. We compared the abilities of the ICP0 related proteins to disrupt
ND10, induce degradation of PML and Sp100, to affect key components of the
interferon signalling pathway and to interfere with induction of interferon
stimulated genes. We found that the property that correlated most closely with
their biological activities was the ability to preclude the recruitment of
cellular ND10 proteins to sites closely associated with incoming HSV-1 genomes
and early replication compartments.

PMID: 20106921 [PubMed - as supplied by publisher]


29. Int J Infect Dis. 2010 Feb;14(2):e141-e146. Epub 2010 Jan 27.

Etiology and clinico-epidemiological profile of acute viral encephalitis in
children of western Uttar Pradesh, India.

Beig FK, Malik A, Rizvi M, Acharya D, Khare S.

Department of Paediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim
University, Aligarh, Uttar Pradesh, India.

OBJECTIVES: To study the etiology of viral encephalitis (VE) in the children of
western Uttar Pradesh, India and to assess the clinico-epidemiological profile of
these children in relation to VE. METHODS: Both cerebrospinal fluid and serum
samples were collected from pediatric patients suffering from encephalitis
hospitalized at Jawaharlal Nehru Medical College, Aligarh from July 2004 to
November 2006. Viral isolation was done on RD cells, HEp-2 cells, and Vero cells 
from the cerebrospinal fluid samples of children with suspected VE. A
microneutralization test was performed for enterovirus 71. An enzyme immunoassay 
for IgM antibodies was performed for measles virus, mumps virus, varicella zoster
virus, herpes simplex virus 1, and Japanese encephalitis virus. RESULTS:
Eighty-seven patients were enrolled in the study. The most common etiology of VE 
was enterovirus 71 (42.1%), followed by measles (21.1%), varicella zoster virus
(15.8%), herpes simplex virus (10.5%), and mumps (10.5%). Japanese encephalitis
virus was not found in any case. Enterovirus 71 infection caused significant
morbidity in children; mortality occurred in 50%. A preponderance of cases
occurred in December. In our study generalized convulsions along with altered
sensorium were the significant findings in patients with VE. CONCLUSIONS:
Enterovirus 71, the major etiology of VE in our study, was associated with
significant mortality and morbidity. Such studies should be conducted frequently 
to assess the role of emerging VE in different regions. Copyright © 2010.
Published by Elsevier Ltd.

PMID: 20106698 [PubMed - as supplied by publisher]


30. Drugs Aging. 2010;27(2):159-76. doi: 10.2165/10489140-000000000-00000.

Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and
postherpetic neuralgia in older adults.

Sanford M, Keating GM.

Adis, a Wolters Kluwer Business, Auckland, New Zealand. demail@adis.co.nz

Individuals who have been infected with varicella zoster virus (VZV) are at risk 
for developing herpes zoster and this risk appears to be related to a decline in 
VZV-specific cell-mediated immunity (CMI). Zostavax (zoster vaccine) is a
one-dose, high-potency, live, attenuated VZV vaccine that boosts VZV-specific CMI
and this is its presumed mechanism of action. Zoster vaccine is registered in the
EU for use in adults aged >or=50 years for the prevention of herpes zoster and
herpes zoster-related postherpetic neuralgia. In the Shingles Prevention Study, a
placebo-controlled trial in adults aged >or=60 years (n = 38 546), zoster vaccine
led to a sustained boost of VZV-specific CMI. Over a mean herpes zoster
surveillance period of 3.1 years, zoster vaccine reduced the herpes
zoster-related burden of illness by 61%, reduced the incidence of herpes zoster
by 51% and reduced the incidence of postherpetic neuralgia by 67%. Zoster vaccine
recipients who developed herpes zoster had a shorter illness duration and
severity than placebo recipients who developed herpes zoster. Zoster vaccine had 
continuing efficacy in a Shingles Prevention Study subpopulation followed for 7
years post-vaccination. Zoster vaccine was generally well tolerated in older
adults. While cost-effectiveness estimates in pharmacoeconomic analyses varied
widely according to vaccine and herpes zoster parameter cost/benefit estimates,
an analysis from a UK perspective found a zoster vaccine immunization programme
in adults aged 65 years to be cost effective. In older adults, the zoster vaccine
has the potential to significantly reduce the herpes zoster burden of illness by 
decreasing the incidence of herpes zoster or reducing its severity.

PMID: 20104941 [PubMed - in process]


31. JAMA. 2010 Feb 24;303(8):733-4. Epub 2010 Jan 26.

Incomplete financial disclosures in an editorial, clinical crossroads, and reply 
letter related to herpes zoster.

Whitley RJ.

Comment on:
    JAMA. 2009 Jul 1;302(1):73-80.
    JAMA. 2009 Nov 4;302(17):1862; author reply 1862-3.
    JAMA. 2009 Feb 18;301(7):774-5.

PMID: 20103745 [PubMed - in process]


32. Eur J Dermatol. 2010 Jan 26. [Epub ahead of print]

Disseminated cutaneous herpes zoster complicated by acyclovir nephrotoxicity and 
successfully treated with brivudin.

Aksoy B, Altaykan-Hapa A, Cengiz A, Mete Aksoy H, Atakan N.

PMID: 20103497 [PubMed - as supplied by publisher]


33. Clin Med. 2009 Dec;9(6):630.

Aciclovir neurotoxicity is an important side effect of therapy in patients with
renal impairment.

Brady M, Main J.

Comment on:
    Clin Med. 2009 Jun;9(3):231-5.

PMID: 20095318 [PubMed - indexed for MEDLINE]


34. Rheumatol Int. 2009 Dec 20. [Epub ahead of print]

Safety of biologic agents after rituximab therapy in patients with rheumatoid
arthritis.

Mishra R, Singh V, Pritchard CH.

Division of Rheumatology, University of Pennsylvania, 827 Penn Tower Bldg, 3401
Civic Center Blvd, Philadelphia, PA, 19104, USA, richa.mishra@uphs.upenn.edu.

The safety of other biologic therapies in rheumatoid arthritis (RA) following B
cell-depletion therapy with rituximab has not been established. This
retrospective chart review of patients attending an outpatient rheumatology
clinic aimed to assess the incidence of adverse events in patients receiving
biologic agents to treat RA after an inadequate response or intolerance to
rituximab. The charts of 22 patients (18 female; mean age 59 years) were
reviewed. Duration of RA was >2 years. Before rituximab, patients had failed one 
(n = 10), two (n = 4) or three (n = 7) biologic therapies: 1 patient started on
rituximab as a first-line biologic. Eighteen patients stopped rituximab due to an
inadequate clinical response, while four patients stopped due to adverse events. 
The mean time to starting a new biologic after rituximab was 4 months, although
five patients were started within 1 month of the last rituximab infusion.
Abatacept (41%) was the most common biologic used after rituximab. The mean
follow-up time from the last rituximab infusion was 14 months. Adverse events
occurring after rituximab therapy, but before initiation of a new biologic,
included disseminated herpes zoster and aseptic meningitis (both required
hospitalization). Adverse events recorded after starting a new biologic
post-rituximab included rash, carbuncle, upper respiratory tract infection,
urinary tract infection, pneumonia, and eczema, but none was classified as
serious. Most of these events occurred in patients receiving abatacept. In
conclusion, in this retrospective analysis, no serious adverse events were
recorded in patients who received biologic agents following rituximab therapy.

PMID: 20091035 [PubMed - as supplied by publisher]


35. N Engl J Med. 2010 Feb 4;362(5):416-26. Epub 2010 Jan 20.

A placebo-controlled trial of oral cladribine for relapsing multiple sclerosis.

Giovannoni G, Comi G, Cook S, Rammohan K, Rieckmann P, Soelberg Sorensen P,
Vermersch P, Chang P, Hamlett A, Musch B, Greenberg SJ; CLARITY Study Group.

Collaborators: Giovannoni G, Comi G, Cook S, Rammohan K, Rieckmann P, Soelberg
Sorensen P, Vermersch P, Sandberg-Wollheim M, Cuzick J, Juliusson G, Reingold S, 
King J, Pollard J, Sedal L, Aichner F, Eggers C, Dive D, Medaer R, Ferreira M,
Manchev I, Milanov I, Haralanov L, Deleva N, Petrova N, Bozhinov P, Zahariev Z,
Stamenov B, Shotekov P, Petrov I, Moskov R, Emond F, Freedman M, Grand'Maison F, 
Jacques F, Vorobeychik G, Demarin V, Kovacicek M, Lusic I, Perhat-Bucevic T,
Havrdova E, Talab R, Kanovsky P, Soelberg Sorensen P, Petersen T, Gross-Paju K,
Kalbe I, Toomsoo T, Elovaara I, Eralinna JP, Reunanen M, Clavelou P, Damier P,
Debouverie M, Edan G, Gout O, Labauge P, Laplaud D, Wiertlewski S, Vermersch P,
Heidenreich F, Maurer M, Kieseier B, Limmroth V, Oschmann P, Schimrigk S,
Steinbrecher A, Zettl U, Ziemann U, Karageorgiou K, Kyritsis A, Papadimitriou A, 
Amato MP, Bernardi G, Morra VB, Comi G, Galgani S, Gallo P, Patti F, Marrosu M,
Pozzilli C, Trojano M, Mancardi GL, Gebeily S, Koussa S, Wehbe M, Yamout B,
Vaitkus A, Metra M, Messouak O, Mossaddaq R, Slassi I, Yahyaoui M, Hupperts RM,
Czlonkowska A, Kozubski W, Nyka W, Selmaj K, Szczudlik A, Figueiredo J, Pedrosa
R, Alifirova V, Balyazin V, Barbarash O, Belova A, Boyko A, Gusev E, Elchaninov
A, Jacoupov E, Julev N, Kotov S, Kudryavtsev A, Laskov V, Lesnyak O, Odinak M,
Pasechnik E, Poverennonva I, Skoromets A, Spirin N, Stolyarov I, Vorobieva O,
Voskresenskaya O, Zaslavskiy L, Zonova E, Bohlega S, El-Jumah M, Drulovic J, Nadj
C, Goebels N, Schluep M, Ayed-Frih M, Hentati F, Mhiri C, Mrabet A, Mrissa R,
Idiman E, Karabudak R, Turan OF, Ahmed F, Constantinescu C, Giovannoni G, Hawkins
C, Palace J, Sharrack B, Loganovsky K, Moskovko S, Nehrych T, Voloshyna NP,
Carlini W, Cook S, English J, Garmany G, Glyman S, Huddlestone J, Hurwitz B,
Kresa-Reahl K, Mikol D, Pardo G, Rammohan K, Rao H, Reif M, Thrower B, Royal W,
Webb R, Wynn D, Naga C, Allen N, Lin K, Stefoski D, Balabanov R.

Queen Mary University London, the Blizard Institute of Cell and Molecular
Science, Barts and the London School of Medicine and Dentistry, London, United
Kingdom. g.giovannoni@qmul.ac.uk

Comment in:
    N Engl J Med. 2010 Feb 4;362(5):456-8.

BACKGROUND: Cladribine provides immunomodulation through selective targeting of
lymphocyte subtypes. We report the results of a 96-week phase 3 trial of a
short-course oral tablet therapy in patients with relapsing-remitting multiple
sclerosis. METHODS: We randomly assigned 1326 patients in an approximate 1:1:1
ratio to receive one of two cumulative doses of cladribine tablets (either 3.5 mg
or 5.25 mg per kilogram of body weight) or matching placebo, given in two or four
short courses for the first 48 weeks, then in two short courses starting at week 
48 and week 52 (for a total of 8 to 20 days per year). The primary end point was 
the rate of relapse at 96 weeks. RESULTS: Among patients who received cladribine 
tablets (either 3.5 mg or 5.25 mg per kilogram), there was a significantly lower 
annualized rate of relapse than in the placebo group (0.14 and 0.15,
respectively, vs. 0.33; P<0.001 for both comparisons), a higher relapse-free rate
(79.7% and 78.9%, respectively, vs. 60.9%; P<0.001 for both comparisons), a lower
risk of 3-month sustained progression of disability (hazard ratio for the 3.5-mg 
group, 0.67; 95% confidence interval [CI], 0.48 to 0.93; P=0.02; and hazard ratio
for the 5.25-mg group, 0.69; 95% CI, 0.49 to 0.96; P=0.03), and significant
reductions in the brain lesion count on magnetic resonance imaging (MRI) (P<0.001
for all comparisons). Adverse events that were more frequent in the cladribine
groups included lymphocytopenia (21.6% in the 3.5-mg group and 31.5% in the
5.25-mg group, vs. 1.8%) and herpes zoster (8 patients and 12 patients,
respectively, vs. no patients). CONCLUSIONS: Treatment with cladribine tablets
significantly reduced relapse rates, the risk of disability progression, and MRI 
measures of disease activity at 96 weeks. The benefits need to be weighed against
the risks. (ClinicalTrials.gov number, NCT00213135.) 2010 Massachusetts Medical
Society

PMID: 20089960 [PubMed - indexed for MEDLINE]


36. N Engl J Med. 2010 Feb 4;362(5):402-15. Epub 2010 Jan 20.

Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis.

Cohen JA, Barkhof F, Comi G, Hartung HP, Khatri BO, Montalban X, Pelletier J,
Capra R, Gallo P, Izquierdo G, Tiel-Wilck K, de Vera A, Jin J, Stites T, Wu S,
Aradhye S, Kappos L; TRANSFORMS Study Group.

Collaborators: Cohen J, Barkhof F, Comi G, Hartung HP, Kappos L, Khatri B,
Montalban X, Pelletier J, Easton JD, Calandra T, DiMarco J, Hudson L, Kesselring 
J, Laupacis A, Temkin N, Weinshenker B, Zarbin M, Barkhof F, Poppe P, Luetic G,
Cristiano E, Caceres F, Garcea O, Correale J, Ballario C, Piedrabuena R, Pollard 
J, Beran R, Hodgkinson S, Schwartz R, Heard R, King J, Butzkueven H, Maida EM,
Vass K, Franta-Elmer C, Berger T, Aichner F, Ladurner G, Bissay V, Sindic C,
D'Hooghe M, Mulleners E, Damasceno B, Barreira A, Naylor R, Alvarenga R, Bacellar
A, Haussen S, Duquette P, Antel J, Lamontagne A, Grand'maison F, Freedman M,
Christie S, O'Connor P, Vorobeychik G, Devonshire V, Ramadan M, Hamdy S, Reda E, 
Hashem S, Fouad M, Lebrun-Frenay C, Pelletier J, Clanet M, Brochet B, Debouverie 
M, Heinzlef O, Ziemssen T, Koehler W, Tiel-Wilck K, Bachus R, Altmann N, Faiss J,
Baum K, Dressel A, Luckner K, Ebke M, Stangel M, Hartung HP, Diener HC, Bethke F,
Limmroth V, Maschke M, Thoemke F, Reifschneider G, Diehm R, Wildemann B, Melms A,
Rauer S, Karlbauer G, Berthele A, Lang M, Tumani H, Krauseneck P, Klein M,
Papadimitriou A, Karageorgiou K, Liakopoulos D, Tascos N, Plaitakis A,
Papathanasopoulos P, Panczel G, Jakab G, Csiba L, Komoly S, Csanyi A, Bartos L,
Centonze D, Pozzilli C, Marrosu MG, Bertolotto A, Mancardi G, Scarpini E, Comi G,
Protti A, Ghezzi A, Capra R, Bergamaschi R, Gallo P, Stecchi S, Montanari E, Tola
MR, Amato MP, Silvestrini M, Lugaresi A, Trojano M, Brescia Morra V, Ruggieri S, 
Patti F, Kim SM, Lee KH, Kim HJ, Park SP, Ginestal R, Salgado AV, Fontoura P,
Cunha L, Sousa L, Sa MJ, Pedrosa R, Montalban X, Arbizu T, Arroyo R, Garcia
Merino JA, Fernandez O, Izquierdo G, Casanova B, Antiguedad A, Goebels N, Kappos 
L, Young C, Lee M, Chaudhuri A, Nicholas R, Chinea Martinez A, Preiningerova J,
Greco D, Gross J, Newman S, Mitchell G, Pawar G, Freedman SM, Kaufman M, Absher
J, Kantor D, Ayala R, Honeycutt W, Shafer S, Steingo B, Delgado S, Cascione M,
Brock C, Keegan A, LaGanke C, Hunter S, Wilson E, Cohen J, Mazhari A, Bauer W,
Khatri B, Singer B, Lynch S, Rowe V, Hutton G, Gazda S, Dihenia B, Campagnolo D, 
Chippendale T, Ash P, Jung L, Olek M.

Mellen Center, Cleveland Clinic, Cleveland, OH 44195, USA. cohenj@ccf.org

Comment in:
    N Engl J Med. 2010 Feb 4;362(5):456-8.

BACKGROUND: Fingolimod (FTY720), a sphingosine-1-phosphate-receptor modulator
that prevents lymphocyte egress from lymph nodes, showed clinical efficacy and
improvement on imaging in a phase 2 study involving patients with multiple
sclerosis. METHODS: In this 12-month, double-blind, double-dummy study, we
randomly assigned 1292 patients with relapsing-remitting multiple sclerosis who
had a recent history of at least one relapse to receive either oral fingolimod at
a daily dose of either 1.25 or 0.5 mg or intramuscular interferon beta-1a (an
established therapy for multiple sclerosis) at a weekly dose of 30 microg. The
primary end point was the annualized relapse rate. Key secondary end points were 
the number of new or enlarged lesions on T(2)-weighted magnetic resonance imaging
(MRI) scans at 12 months and progression of disability that was sustained for at 
least 3 months. RESULTS: A total of 1153 patients (89%) completed the study. The 
annualized relapse rate was significantly lower in both groups receiving
fingolimod--0.20 (95% confidence interval [CI], 0.16 to 0.26) in the 1.25-mg
group and 0.16 (95% CI, 0.12 to 0.21) in the 0.5-mg group--than in the interferon
group (0.33; 95% CI, 0.26 to 0.42; P<0.001 for both comparisons). MRI findings
supported the primary results. No significant differences were seen among the
study groups with respect to progression of disability. Two fatal infections
occurred in the group that received the 1.25-mg dose of fingolimod: disseminated 
primary varicella zoster and herpes simplex encephalitis. Other adverse events
among patients receiving fingolimod were nonfatal herpesvirus infections,
bradycardia and atrioventricular block, hypertension, macular edema, skin cancer,
and elevated liver-enzyme levels. CONCLUSIONS: This trial showed the superior
efficacy of oral fingolimod with respect to relapse rates and MRI outcomes in
patients with multiple sclerosis, as compared with intramuscular interferon
beta-1a. Longer studies are needed to assess the safety and efficacy of treatment
beyond 1 year. (ClinicalTrials.gov number, NCT00340834.) 2010 Massachusetts
Medical Society

PMID: 20089954 [PubMed - indexed for MEDLINE]


37. Gan To Kagaku Ryoho. 2010 Jan;37(1):99-102.

[Alteration in antibody-mediated immunity in patients with rituximab-combined
chemotherapy and incidence of herpes zoster]

[Article in Japanese]

Ito K, Okamoto M, Maruyama F, Handa K, Yamamoto Y, Watanabe M, Tsuzuki M, Mizuta 
S, Kumazawa S, Ohta H, Nakano I, Emi N.

Department of Pharmacy, Fujita Health University Hospital, Japan.

Rituximab, a chimeric monoclonal antibody against the CD20 protein, has an
antineoplastic effect resulting from antibody dependent cellular cytotoxicity
(ADCC) and complement-dependent cytotoxicity (CDC). In patients with
rituximab-combined chemotherapy, a decline in immunoglobulin can be observed.
This is more likely to cause virus reactivation, such as Herpes (H) zoster.
However, this fact has not reported in a large-scale study. In order to research 
immunodeficiency conditions in patients with rituximab-combined therapy, we
examined the alteration in immunoglobulin level throughout the treatment among
205 cases with B-cell lymphoma. We also studied the prevalence of H. zoster in
those cases. The IgG level throughout the treatment was measured in 89 patients
in the research. The median post-chemotherapy IgG level was 41.1% lower than its 
pre-chemotherapy IgG level. In 58 cases, the IgG level following chemotherapy was
below the normal level. In 22 cases, the IgG level dropped to less than half of
the pre-chemotherapy level. H. zoster developed in 17 cases (8.3%). There was no 
significant difference in IgG level between H. zoster-onset cases and non-H.
zoster-onset cases. Antibody-mediated immunity can decrease greatly and prolong
in cases with rituximab in combination with chemotherapy. Therefore, infection
control is considered to be important.

PMID: 20087040 [PubMed - indexed for MEDLINE]


38. Cad Saude Publica. 2009;25 Suppl 3:S401-14.

Impact of methodology on the results of economic evaluations of varicella
vaccination programs: is it important for decision-making?

de Soarez PC, Novaes HM, Sartori AM.

Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, Brasil. pcsoarez@uol.com.br

This study aims to review the literature on economic evaluation of childhood
varicella vaccination programs and to discuss how heterogeneity in methodological
aspects and estimation of parameters can affect the studies' results. After
applying the inclusion criteria, 27 studies published from 1980 to 2008 were
analyzed in relation to methodological differences. There was great heterogeneity
in the perspective adopted, evaluation of indirect costs, type of model used,
modeling of the effect on herpes zoster, and estimation of vaccine price and
efficacy parameters. The factor with the greatest impact on results was the
inclusion of indirect costs, followed by the perspective adopted and vaccine
price. The choice of a particular methodological aspect or parameter affected the
studies' results and conclusions. It is essential that authors present these
choices transparently so that users of economic evaluations understand the
implications of such choices and the direction in which the results of the
analysis were conducted.

PMID: 20027388 [PubMed - in process]


39. Proc Natl Acad Sci U S A. 2010 Jan 12;107(2):866-71. Epub 2009 Dec 22.

Myelin-associated glycoprotein mediates membrane fusion and entry of neurotropic 
herpesviruses.

Suenaga T, Satoh T, Somboonthum P, Kawaguchi Y, Mori Y, Arase H.

Department of Immunochemistry, Research Institute for Microbial Diseases and WPI 
Immunology Frontier Research Center, Osaka University, Suita, Osaka 565-0871,
Japan.

Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are prevalent
neurotropic herpesviruses that cause various nervous system diseases. Similar to 
other enveloped viruses, membrane fusion is an essential process for viral entry.
Therefore, identification of host molecules that mediate membrane fusion is
important to understand the mechanism of viral infection. Here, we demonstrate
that myelin-associated glycoprotein (MAG), mainly distributed in neural tissues, 
associates with VZV glycoprotein B (gB) and promotes cell-cell fusion when
coexpressed with VZV gB and gH/gL. VZV preferentially infected MAG-transfected
oligodendroglial cells. MAG also associated with HSV-1 gB and enhanced HSV-1
infection of promyelocytes. These findings suggested that MAG is involved in VZV 
and HSV infection of neural tissues.

PMCID: PMC2818916 [Available on 2010/7/12]
PMID: 20080767 [PubMed - in process]


40. Radiat Oncol. 2010 Jan 16;5(1):3.

Tailored total lymphoid irradiation in heart transplant patients: 10-years
experience of one center.

Ghadjar P, Joos D, Martinelli M, Hullin R, Zwahlen M, Lossl K, Carrel T,
Aebersold DM, Mohacsi P.

Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University
Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland. Paul.mohacsi@insel.ch.

ABSTRACT: BACKGROUND: To assess safety and efficacy of tailored total lymphoid
irradiation (tTLI) in cardiac transplant patients. METHODS: A total of seven
patients, of which five had recalcitrant cellular cardiac allograft rejection
(RCCAR), confirmed by endomyocardial biopsies, and two had side effects of
immunosuppressive drug therapy, were all treated with tTLI. tTLI was defined by
the adjustment of both the fraction interval and the final irradiation dosage
both being dependent on the patients general condition, irradiation-dependent
response, and the white blood and platelet counts. A mean dose of 6.4 Gy (range, 
1.6 - 8.8 Gy) was given. Median follow-up was 7 years (range, 1.8 - 12.2 years). 
RESULTS: tTLI was well tolerated. Two patients experienced a severe infection
during tTLI (pneumocystis jirovecii pneumonia, urosepsis and generalized herpes
zoster) and one patient developed a lymphoproliferative disorder after tTLI. The 
rate of rejection episodes before tTLI was 0.43 episodes/patient/month and
decreased to 0.02 episodes/patient/month after tTLI (P < .001). At the end of the
observation time, all patients except one were alive. CONCLUSIONS: tTLI is a
useful treatment strategy for the management of RCCAR and in patients with
significant side effects of immunosuppressive drug therapy. In this series tTLI
demonstrated significantly decreased rejection rates without causing relevant
treatment-related toxicity.

PMCID: PMC2822786
PMID: 20078889 [PubMed - in process]


41. Zhongguo Ji Hua Mian Yi. 2009 Aug;15(4):327-9.

[Epidemiological characteristic of Varicella and Varicella-Zoster virus genotype 
in Minhang District of Shanghai]

[Article in Chinese]

Du Y, Jiang LF, Zhang LP.

Minhang District Center for Disease Control and Prevention of Shanghai, Shanghai 
201101, China.

OBJECTIVE: To describe the epidemiological characteristic of varicella, and to
find out the genotype of the prevalent Varicella-Zoster Virus (VZV) in Minhang,
Shanghai. Analysis was carried out during Nov. 2007 to Apr 2008. METHODS: The
data collected from the National Diseases Reporting Management System (NDRS) and 
Provincial Disease Surveillance Point System (DSP). Samples from herpes of
patients were also collected to isolate VZV in Vero and Vero-E6 cell lines, then 
to detected if cytopathic effect (CPE) by PCR, and finally to identify the
genotype by sequence analysis. RESULTS: 29 outbreaks of 271 cases occurred in
Minhang during Nov. 2007 to Apr. 2008, and attack rate was 0.42% in average.
Among the cases, 37 (13.65%) had vaccinated before getting varicella. Most cases 
occurred in November and December, and clustered in some areas with population
migrant frequently. 2 VZV strains were isolated and identified as genotype J.
CONCLUSION: The prevalence of varicella in Minhang was serious. The varicella
prevention and control among schools and kindergartens should be strengthened by 
propaganda and vaccination.

PMID: 20077731 [PubMed - indexed for MEDLINE]


42. Zhongguo Ji Hua Mian Yi. 2009 Feb;15(1):78-82.

[Varicella]

[Article in Chinese]

Xu ST.

State Key Laboratory for Molecular Virology and Genetic Engineering, Institute
for Viral Disease Control and Prevention, Chinese Center for Disease Control and 
Prevention, Beijing 100050, China.

Varicella is an acute, highly contagious respiratory and caused by
Varicella-zoster virus (VZV). After the primary infection, VZV induce Varicella, 
then the virus remains dormant in sensory nerve roots in life. Upon the
reactivation, shingles can occur. Most of patients can recovery very soon, but
kinds of potentially severe complication can induce death. Nowadays the VZV
vaccination isn't included in the expanded immunization program in our country.
Varicella outbreaks take place at times in the middle of children of our country.
The paper offers concise description about pathogen characteristics, diagnosis
methods, clinical character, epidemiology knowledge and strategy of prevention.

PMID: 20077683 [PubMed - indexed for MEDLINE]


43. Zhongguo Ji Hua Mian Yi. 2009 Apr;15(2):127-30.

[Isolation identification and serological analysis on varicella-zoster virus from
an outbreak in Shanghai in 2007]

[Article in Chinese]

Lu J, Li CS, Hu JY.

Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336,
China.

OBJECTIVE: To make serological analysis and identify the etiology of an outbreak 
of chickenpox in Zhabei District of Shanghai in 2007. METHODS: IgM and IgG of the
paired serums were detected by ELISA. The collected herpes were inoculated into
MRC-5 cells to get VZV isolations and identify them by VZV standard serums. A
268bp fragment was amplified by specific PCR primers. RESULTS: Among the five
paired serums, two of the acute phase serums were VZV IgM positive, one was VZV
IgG positive, and two were equivocal for anti-VZV IgG. All of the convalescent
serums were VZV IgG positive, and four of them were 4 times higher in antibody
titer than those of acute phase serums. Viruses were isolated from all of the 5
herpes, and then identified by VZV standard serum. The electrophoresis result of 
PCR products showed the single specific strap. CONCLUSIONS: This outbreak was
caused by VZV virus. 47.4% of the patients were inoculated in postnatal or
domestic VZV vaccines in China 3 years after delivery. The effectiveness of VZV
vaccine has been certified. It is necessary to consider the immunization strategy
of VZV vaccine.

PMID: 20077657 [PubMed - indexed for MEDLINE]


44. Am J Public Health. 2010 Jan 14. [Epub ahead of print]

Herpes Zoster and Exposure to the Varicella Zoster Virus in an Era of Varicella
Vaccination.

Donahue JG, Kieke BA, Gargiullo PM, Jumaan AO, Berger NR, McCauley JS, Belongia
EA.

Marshfield Clinic Research Foundation.

Objectives. We performed a case-control study to determine if participants with
herpes zoster had fewer contacts with persons with varicella or zoster, and with 
young children, to explore the hypothesis that exposure to persons with varicella
zoster virus (VZV) results in "immune boosting."Methods. Participants were
patients of the multispecialty Marshfield Clinic in Wisconsin. We identified
patients aged 40 to 79 years with a new diagnosis of zoster from August 2000 to
July 2005. We frequency matched control participants to case participants for
age. We confirmed diagnoses by chart review and assessed exposures by
interview.Results. Interviews were completed by 633 of 902 eligible case
participants (70.2%) and 655 of 1149 control participants (57.0%). The number of 
varicella contacts was not associated with zoster; there was no trend even at the
highest exposure level (3 or more contacts). Similarly, there was no association 
with exposure to persons with zoster or to children, or with workplace
exposures.Conclusions. Although exposure to VZV in our study was relatively low, 
the absence of a relationship with zoster reflects the uncertain influence of
varicella circulation on zoster epidemiology.

PMID: 20075320 [PubMed - as supplied by publisher]


45. Rinsho Ketsueki. 2009 Dec;50(12):1720-4.

[Multiple autologous transplantations with intermediate-dose melphalan for two
elderly patients with relapsed or refractory diffuse large B-cell lymphoma]

[Article in Japanese]

Nishimoto T, Hatanaka K, Matsuoka A, Ueda K, Yonetani N, Tamaki T.

Department of Hematology, Rinku General Medical Center Izumisano Municipal
Hospital.

High-dose chemotherapy supported by autologous peripheral blood stem cell
transplantation (PBSCT) is beneficial for patients with relapsed or refractory
but chemosensitive diffuse large B-cell lymphoma (DLBCL). However, most elderly
patients are not indicated for that therapy and receive supportive treatment
only. We describe here two elderly patients with relapsed or refractory DLBCL who
achieved prolonged disease-free survival after undergoing intermediate-dose
melphalan therapy supported by PBSCT (MEL100) three times. Case 1 was an early
relapse (within one year) after the first remission and case 2 was a second
relapse. Both cases are currently alive without relapse and have maintained a
good performance status for 41 months and 32 months, respectively, after MEL100. 
Febrile neutropenia and herpes zoster as non-hematological toxicities (grade > or
= 3) occurred only in case 1. Considering the benefits vs. toxic effects, this
regimen may improve the prognosis of elderly patients with relapsed or refractory
DLBCL by MEL100.

PMID: 20068281 [PubMed - in process]


46. Rheumatol Int. 2010 Jan 12. [Epub ahead of print]

A case of rheumatoid arthritis presenting with postherpetic neuralgia and
abdominal-wall pseudohernia.

Dobrev HP, Atanassova PA, Sirakov VN, Zisova LG.

Department of Dermatology, Medical University, Plovdiv, 4000, Bulgaria.

Postherpetic neuralgia is a common complication, while the postherpetic
abdominal-wall pseudohernia (AWP) is a quite rare complication of herpes zoster
(HZ). We report a patient >45 years of age with a history of rheumatoid arthritis
(RA) who presented with two chronic HZ complications. A 75-year-old woman was
admitted with neuralgia following cutaneous herpes zoster 6 weeks before. She was
on long-term glucocorticoid, antimalarial and non-steroidal anti-inflammatory
treatment. Confluent ulcers began to fill with granulation tissue, crusts, scars 
and skin discoloration in the area of the left T12-L2 dermatomes and reducible,
painless swelling of the left flank, 20 x 20 cm, without palpable defect in
abdominal-wall. There were typical joint deformity and positive rheumatoid
factor. On neurological examination superficial abdominal reflexes were
diminished in the left side, with hypesthesia of the overlying skin. Needle
electromyography revealed denervational changes limited to the left-side muscles 
(on affected dermatomes T12-L2). Thoracoabdominal CT did not reveal the presence 
of existing hernia. There was an abdominal distension, the left abdominal-wall
was thinner than the right side. The patient was treated with an oral preparation
containing benfotiamine and vitamins B6 and B12, carbamazepine, amitriptyline,
gabapentin, and local lidocaine. Skin rash left with scarring and pigmentary
changes and the abdominal-wall swelling resolved within 8 months, however, the
pain still persisted. To our best knowledge, this is the first observation of
RA-associated postherpetic AWP. This rare motor complication appears to be
self-limited with a good prognosis for recovery, while postherpetic neuralgia may
require a combination of treatments for adequate pain relief. Older age, female
sex, greater rash and acute pain severity are considered as risk factors
associated with severe postherpetic neuralgia. In addition, patients with RA,
mainly those treated with oral corticosteroids, are also at increased risk of HZ 
complications.

PMID: 20066424 [PubMed - as supplied by publisher]


47. Surg Oncol. 2010 Jan 5. [Epub ahead of print]

Neuropathic pain and its assessment.

Cruccu G, Truini A.

Department of Neurological Sciences, University La Sapienza, Rome, Italy; IRCCS
San Raffaele Pisana, Rome, Italy.

Neuropathic pain, i.e., pain arising as a direct consequence of a lesion or
disease affecting the somatosensory system, is a frequent complaint in the
elderly. The frequency of herpes zoster and peripheral neuropathy, the commonest 
diseases that cause neuropathic pain, increases with age. More than half of all
persons in whom herpes zoster develops are older than 60 years and about 30% of
these patients will ultimately suffer from chronic postherpetic neuralgia. The
prevalence of peripheral neuropathy rises from 2.4% in the general population to 
8% in subjects older than 55 years. With advancing age, the nociceptive pathway
undergoes degenerative changes, mainly consisting of axonal loss. This
age-related nociceptive pathway degeneration probably explains why elderly
patients tend to under-report pain in many medical conditions including
myocardial infarction, fractures, and arthritis. This age-related impairment
probably plays a key role in the development of neuropathic pain. In this report 
we describe the most reliable methods for assessing neuropathic pain such as
laser evoked potential (LEP) recordings and skin biopsy, procedures that
selectively assess nociceptive pathways in order to obtain a rapid diagnosis and 
hence determine treatment. Copyright © 2009. Published by Elsevier Ltd.

PMID: 20056406 [PubMed - as supplied by publisher]


48. Acta Clin Croat. 2009 Sep;48(3):359-65.

Neuropathic pain.

Basic-Kes V, Zavoreo I, Bosnar-Puretic M, Ivankovic M, Bitunjac M, Govori V,
Demarin V.

University Department od Neurology, Reference Center for Neurovascular Disorders,
Ministry of Health and Social Welfare of Republic of Croatia, Sestre milosrdnice 
University Hospital, Zagreb. vanjakes@net.hr

Neuropathic pain refers to pain that originates from pathology of the nervous
system. Common causes of neuropathic pain are diabetes mellitus, reactivation of 
herpes zoster, nerve compression or radiculopathy, alcohol, chemotherapy or abuse
of some drugs, and trigeminal neuralgia. Specific symptoms of neuropathic pain
are mechanical allodynia and cold hyperalgesia. Drugs to treat neuropathic pain
can be divided into adjuvant analgesics (antidepressants and anticonvulsants),
opioids and topical agents. The use of multiple drug therapies is common in
practice. Despite considerable increase in the number of randomized
placebo-controlled trials in neuropathic pain in the last few years, the medical 
treatment of neuropathic pain is still far from being satisfactory, with less
than half of patients achieving significant benefit with any pharmacological
drug.

PMID: 20055264 [PubMed - indexed for MEDLINE]


49. Indian J Dermatol. 2009;54(1):62-4.

Childhood herpes zoster: a clustering of ten cases.

Prabhu S, Sripathi H, Gupta S, Prabhu M.

Department of Skin and STD, Kasturba Medical College, Manipal, India.

Herpes zoster occurs due to reactivation of the latent varicella zoster virus and
is usually a disease of the elderly. Childhood herpes zoster is believed to be
rare, though recent studies suggest increasing incidence in children. Here we
report ten cases of childhood herpes zoster, seven of which occurred within a
short span of six months, at a tertiary care level hospital in Pokhara, Nepal.
Only three of the ten children reported previous history of varicella infection
and none was immunized against varicella. Though childhood herpes zoster
accounted for less than 1% of the total zoster cases in the past, recent reports 
show an increase in the number of cases in apparently healthy children. So far,
no studies have been done linking childhood herpes zoster with HIV, though there 
are many studies linking it with other immunocompromised conditions.

PMCID: PMC2800875
PMID: 20049274 [PubMed - in process]


50. Wien Klin Wochenschr. 2009;121(23-24):776-9.

Ischemic stroke associated with adenoviral infection in a 4-year-old boy.

Kutlesa M, Tesovic G, Knezovic I, Mise B, Viskovic K, Barisic N.

Department of Pediatric Infectious Diseases, University Hospital for Infectious
Diseases Dr. Fran Mihaljevic, Zagreb, Croatia. kutlesam@yahoo.com

We present a case of childhood arterial ischemic stroke associated with proven
adenoviral upper respiratory tract infection in a previously healthy 4-year-old
boy. Adenoviral meningitis and encephalitis have been reported repeatedly, thus
confirming the neuroinvasive capability of these viruses. However, an association
between adenoviral infection and arterial ischemic stroke has not been described 
thus far. HIV and varicella zoster virus are the only microorganisms that have
been consistently associated with arterial ischemic stroke in the absence of
acute central nervous system infection. In HIV-infected individuals ischemic
stroke can be caused by vasculitis and hypercoagulability. Granulomatous
arteritis of the vessel wall causes post-varicella cerebral infarction and
ischemic stroke after herpes zoster ophthalmicus. We suggest that in our patient 
a post-varicella cerebral infarction-like mechanism of adenoviral spread to the
affected artery wall occurred through the ophthalmic branch of the trigeminal
nerve. Adenoviruses are neuroinvasive and inflamed conjunctiva might have
permitted introduction of the virus into ophthalmic nerve tissue. In consequence,
the stenotic lesion of the artery might have been induced by the presence of
adenovirus and the subsequent inflammatory reaction. We recommend a prompt quest 
for adenoviral infection in all previously healthy children with fever and
clinical presentation compatible with ischemic stroke, because timely diagnosis
and treatment could improve the outcome and hasten neurological recovery.

PMID: 20047116 [PubMed - in process]


51. Acta Dermatovenerol Alp Panonica Adriat. 2009 Dec;18(4):179-82.

Zosteriform lymphangioma circumscriptum.

Patel GA, Siperstein RD, Ragi G, Schwartz RA.

Dermatology, New Jersey Medical School, 185 South Orange Avenue, Newark, New
Jersey 07103-2714, USA.

Lymphangioma circumscriptum (LC) is a form of lymphangioma involving skin and
subcutaneous tissue. It is evident as translucent vesicles of varying size,
though commonly 2 to 4 mm, and of a pink, red, or black hue. It is localized to
the dermis, frequently extending deeply and laterally. LC may resemble other
entities, such as metastatic carcinoma of the skin, lymphangiectasis, or herpes
zoster. We report an unusual verruciform, zosteriform form of LC.

PMID: 20043057 [PubMed - in process]


52. Neurology. 2010 Jan 5;74(1):85-6.

Polyneuritis cranialis caused by varicella zoster virus in the absence of rash.

Murata KY, Miwa H, Kondo T.

Department of Neurology, Wakayama Medical University, 840-1 Kimiidera, Wakayama, 
Japan 641-8510. kemurata@wakayama-med.ac.jp

PMID: 20038777 [PubMed - indexed for MEDLINE]


53. Antimicrob Agents Chemother. 2010 Mar;54(3):1146-51. Epub 2009 Dec 28.

Pharmacokinetics of acyclovir and its metabolites in cerebrospinal fluid and
systemic circulation after administration of high-dose valacyclovir in subjects
with normal and impaired renal function.

Smith JP, Weller S, Johnson B, Nicotera J, Luther JM, Haas DW.

Division of Infectious Diseases, Vanderbilt University School of Medicine, 345
24th Avenue North, Suite 105, Nashville, TN 37203. david.w.haas@vanderbilt.edu.

Valacyclovir, the l-valyl ester prodrug of acyclovir (ACV), is widely prescribed 
to treat infections caused by varicella-zoster virus or herpes simplex virus.
Rarely, treatment is complicated by reversible neuropsychiatric symptoms. By
mechanisms not fully understood, this occurs more frequently in the setting of
renal impairment. We characterized the steady-state pharmacokinetics of ACV and
its metabolites 9-[(carboxymethoxy)methyl]guanine (CMMG) and 8-hydroxy-acyclovir 
(8-OH-ACV) in cerebrospinal fluid (CSF) and the systemic circulation. We
administered multiple doses of high-dose valacyclovir to 6 subjects with normal
renal function and 3 subjects with chronic renal impairment (creatinine clearance
[CrCl], approximately 15 to 30 ml/min). Dosages were 2,000 mg every 6 h and 1,500
mg every 12 h, respectively. Indwelling intrathecal catheters allowed serial CSF 
sampling throughout the dosing interval. The average steady-state concentrations 
of acyclovir, CMMG, and 8-OH-ACV were greater in both the systemic circulation
and the CSF among subjects with impaired renal function than among subjects with 
normal renal function. However, the CSF penetration of each analyte, reflected by
the CSF-to-plasma area under the concentration-time curve over the 6- or 12-h
dosing interval (AUC(tau)) ratio, did not differ based on renal function. Renal
impairment does not alter the propensity for ACV or its metabolites to distribute
to the CSF, but the higher concentrations in the systemic circulation, as a
result of reduced elimination, are associated with proportionally higher
concentrations in CSF.

PMCID: PMC2825963 [Available on 2010/9/1]
PMID: 20038622 [PubMed - in process]


54. Hawaii Med J. 2009 Dec;68(11):277-8.

Varicella zoster virus infection in patients taking the TNF-alpha inhibitor,
etanercept: coincidence or causal?

Izumi A.

Department of Dermatology, John A. Burns School of Medicine, University of
Hawai'i, Honolulu, HI 96813, USA.

Ninety percent of varicella infections are seen in children under the age of ten 
and usually follow a benign clinical course with complete resolution of symptoms 
in one to three weeks. Herpes zoster an acute vesicular eruption due to the
varicella-zoster virus (VZV), occurs mostly in adults. Biologic agents include
tumor necrosis factor alpha (TNF-alpha) inhibitors that have significantly
impacted the treatment of autoimmune and inflammatory conditions. Therapy with
TNF-alpha inhibitors poses a potential risk of serious infections secondary to
their immunomodulating properties; however multiple studies have demonstrated
acceptable safety and tolerability profiles. A case of documented VZV infection
(varicella) in an adult receiving the TNF-alpha inhibitor etanercept is described
here.

PMID: 20034255 [PubMed - indexed for MEDLINE]


55. Antivir Ther. 2009;14(8):1051-64.

Herpesviridae and novel inhibitors.

Siakallis G, Spandidos DA, Sourvinos G.

Department of Virology, Faculty of Medicine, University of Crete, Crete, Greece.

Herpesviridae comprises a large family of double-stranded DNA viruses that infect
both animals and humans. Eight herpesviruses are known to infect humans: herpes
simplex virus type-1 and -2, varicella zoster virus, human cytomegalovirus,
Epstein-Barr virus, human herpesvirus 6 type-A and -B, human herpesvirus type-7
and -8 or Kaposi's sarcoma virus. Despite the fact that the past two decades have
been evolutionary in the development of antiviral agents, therapeutic choices are
restricted by limited efficacy and toxicity. Viral infections remain the cause of
significant mortality worldwide, thus indicating the high medical need for the
introduction of novel promising compounds in the antiviral chemotherapy era. This
review focuses on recent data regarding several novel groups of agents that have 
proved to be effective as antiherpetic drugs. The agents mentioned are those
considered to be the most likely candidates for entering clinical trials and
those in the process of being granted approval by the US Food and Drug
Administration. The diversity in their molecular mechanism of action highlights
the different perspectives currently encountered in the era of antiviral therapy.

PMID: 20032535 [PubMed - in process]


56. Ophthalmology. 2009 Dec 21. [Epub ahead of print]

Acute Retinal Necrosis The Effects of Intravitreal Foscarnet and Virus Type on
Outcome.

Wong R, Pavesio CE, Laidlaw DA, Williamson TH, Graham EM, Stanford MR.

Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom;
Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.

PURPOSE: To study the effects of intravitreal foscarnet and the clinical
differences between varicella zoster virus (VZV-ARN) and herpes simplex virus
(HSV-ARN) induced acute retinal necrosis. DESIGN: Retrospective comparative case 
series. PARTICIPANTS: Eighty-one eyes of 74 patients. METHODS: A retrospective
case note analysis was performed in 2 tertiary referral centers. MAIN OUTCOME
MEASURES: Presenting and final visual acuity, and progression to retinal
detachment. RESULTS: Thirty-three eyes had HSV-ARN and 48 had VZV-ARN. The
average age for HSV-ARN was 34 years and 51 for VZV-ARN (P<0.001). Visual acuity 
on presentation was similar (P = 0.48), but a larger proportion had better vision
(>/=20/60) in the HSV-ARN group (52%) than the VZV-ARN group (35%). A greater
proportion of eyes with poor vision (</=20/200) was found at the 12-month
follow-up in the VZV-ARN group (60%) compared with the HSV-ARN group (35%). A
greater degree of visual loss in the VZV-ARN group (0.4 logarithm of the minimum 
angle of resolution [logMAR]) compared with the HSV-ARN group (0.04 logMAR) was
detected (P = 0.016). Retinal detachment was 2.5-fold more common in VZV-ARN
(62%) compared with HSV-ARN (24%). When comparing eyes treated with (n = 56) and 
without (n = 25) intravitreal foscarnet, there was a 40% lower rate in retinal
detachment (53.6% vs 75.0%) for VZV-ARN (P = 0.23). The numbers with HSV-ARN were
too small for analysis. CONCLUSIONS: The results support the difference of
outcome in HSV-ARN and VZV-ARN. Therefore, viral identification serves as a key
to predicting outcome in these patients. Intravitreal foscarnet seems to be a
useful adjunct for the treatment of ARN in that it reduced rate of retinal
detachment. FINANCIAL DISCLOSURE(S): The authors have no proprietary or
commercial interest in any of the materials discussed in this article. Copyright 
© 2009 American Academy of Ophthalmology. Published by Elsevier Inc. All rights
reserved.

PMID: 20031221 [PubMed - as supplied by publisher]


57. J Med Virol. 2010 Feb;82(2):345-9.

Detection of varicella-zoster virus DNA in 414 human trigeminal ganglia from
cadavers by the polymerase chain reaction: a comparison of the detection rate of 
varicella-zoster virus and herpes simplex virus type 1.

Inoue H, Motani-Saitoh H, Sakurada K, Ikegaya H, Yajima D, Hayakawa M, Sato Y,
Otsuka K, Kobayashi K, Nagasawa S, Iwase H.

Department of Legal Medicine, Graduate School of Medicine, Chiba University,
Chiba, Japan. inoue@restaff.chiba-u.jp

Investigation of varicella-zoster virus (VZV) is important epidemiologically, and
determination of its prevalence rate in human trigeminal ganglia is important to 
provide surveillance data. To date, studies on VZV detection in trigeminal
ganglia have used specimens obtained from a relatively limited number of
cadavers. This study attempted to detect VZV DNA as well as Herpes simplex virus 
type 1 (HSV-1) DNA by the polymerase chain reaction (PCR) from 414 samples of
trigeminal ganglia obtained from 207 cadavers selected at random. The detection
rate was examined to determine whether there were significant differences in the 
positive rate between the left and right trigeminal ganglia, males and females,
and among age groups. A relationship was found between the positive rates for VZV
and HSV-1. VZV DNA was detected in 391 of the trigeminal ganglia (94.4%) and 201 
of the cadavers (97.1%) in 121/124 males and 80/83 females. HSV-1 DNA was
detected in 251 of the samples (60.6%) and 134 of the cadavers (64.7%) in 72/124 
males and 62/83 females. There was no significant difference for either virus in 
the detection rates between the left and right trigeminal ganglia and males and
females. Age and positivity for HSV-1, but not VZV, showed a significant
relationship. All 134 cadavers positive for HSV-1 were also positive for VZV. VZV
and HSV-1 become latent in bilateral trigeminal ganglia, and are not affected by 
gender. The prevalence of HSV-1 was greater in advanced age, and the
HSV-1-positive rate was correlated with the VZV-positive rate. (c) 2009
Wiley-Liss, Inc.

PMID: 20029810 [PubMed - in process]


58. Nat Rev Clin Oncol. 2010 Jan;7(1):55-8.

Interaction between capecitabine and brivudin in a patient with breast cancer.

Baena-Canada JM, Martinez MJ, Garcia-Olmedo O, Jimenez-Barcenas R, Muriel-Cueto
P; Medscape.

Medical Oncology Unit, Puerta del Mar University Hospital, Avenida Ana de Viya
21, Cadiz, Spain. josem.baena.sspa@juntadeandalucia.es

BACKGROUND: A 66-year-old woman with metastatic mammary carcinoma, who was being 
treated with capecitabine, contracted a herpes zoster infection that was treated 
with the antiviral drug brivudin. A drug-drug interaction between brivudin and
capecitabine caused medullar aplasia, serious toxic effects to the intestinal
mucous membrane, hand-foot syndrome, onycholysis and dental pigmentation.
INVESTIGATIONS: Physical examination, blood analysis, blood cultures, chest
X-ray, bone marrow aspiration and biopsy. DIAGNOSIS: Serious adverse event
secondary to inhibition of dihydropyrimidine dehydrogenase by a drug-drug
interaction between capecitabine and brivudin. MANAGEMENT: Intravenous hydration,
imipenem, red blood cell and platelet transfusions, filgrastim, omeprazole, care 
of the mouth and feet, topical anesthetics, systemic analgesics and parenteral
nutrition.

PMID: 20029444 [PubMed - in process]


59. Adv Skin Wound Care. 2009 Nov;22(11):502-5.

Herpes zoster affecting the lower extremity.

Paskey KM, Dunn SP, Vlahovic TC.

Temple University Hospital, Philadelphia, Pennsylvania, USA.

PMID: 20026931 [PubMed - in process]


60. Clin Infect Dis. 2010 Jan 15;50(2):221-8.

Pharmacokinetics and safety of extemporaneously compounded valacyclovir oral
suspension in pediatric patients from 1 month through 11 years of age.

Kimberlin DW, Jacobs RF, Weller S, van der Walt JS, Heitman CK, Man CY, Bradley
JS.

Department of Pediatrics, University of Alabama, Birmingham, AL 35233, USA.
dkimberlin@peds.uab.edu

BACKGROUND: Valacyclovir provides enhanced acyclovir bioavailability in adults,
but limited data are available in children. METHODS: Children 1 month through 5
years of age with or at risk for herpesvirus infection received a single 25 mg/kg
dose of extemporaneously compounded valacyclovir oral suspension (n = 57),
whereas children 1 through 11 years of age received 10 mg/kg valacyclovir oral
suspension twice daily for 3-5 days (herpes simplex virus infection) (n = 28) or 
20 mg/kg 3 times daily for 5 days (varicella-zoster virus infection) (n = 27).
Blood samples for pharmacokinetic analysis were collected during the 6 h after
the first dose. Safety was monitored throughout the studies. RESULTS: Dose
proportionality in the maximum observed concentration (C(max)) of acyclovir and
the area under the concentration-time curve from time zero extrapolated to
infinity (AUC(0-infinity)) existed across the 10 to 20 mg/kg valacyclovir dose
range. For children 2 through 5 years of age, an increase in dose from 20 to 25
mg/kg resulted in near doubling of the C(max) and AUC(0-infinity). Among infants 
1 through 2 months of age receiving 25 mg/kg, the mean AUC(0-infinity) and C(max)
were higher ( approximately 60% and 30%, respectively) than those among older
infants and children receiving the same dose. Valacyclovir oral suspension was
well tolerated. No clinically significant trends were noted in clinical chemical,
hematologic, or urinalysis values from screening to follow-up. CONCLUSIONS: Among
children 3 months through 11 years of age, the 20 mg/kg dose of this formulation 
of valacyclovir oral suspension produces favorable acyclovir blood concentrations
and is well tolerated. A dosing recommendation cannot be made for infants <3
months of age because of decreased clearance in this age group. Trial
registration. ClinicalTrials.gov identifier: NCT00297206 .

PMID: 20014952 [PubMed - in process]


61. Appl Opt. 2009 Dec 10;48(35):6734-9. doi: 10.1364/AO.48.006734.

Linear polarization difference imaging and its potential applications.

Nan Z, Xiaoyu J, Qiang G, Yonghong H, Hui M.

Laboratory of Optical Imaging and Sensing, Graduate School at Shenzhen,Tsinghua
University, Shenzhen, 518055, China.

We demonstrate a novel linear polarization imaging technique and its potential
application in dermatology. This technique records a series of images
corresponding to different combinations of illumination and detection
polarization and calculates intensity differences between orthogonal detection
polarizations pixel by pixel. Fitting the polarization difference data to an
analytical expression of the incident and detection polarization angles results
in two new parameters, G and (phi3)/2. It is shown that G is strongly correlated 
to the order of alignment of the fibrous structure in the sample, and (phi3)/2
represents the angle of orientation of the fibers. Preliminary clinical testing
implies that this method may be applied for medical diagnosis of skin diseases.

PMID: 20011013 [PubMed - indexed for MEDLINE]


62. Otol Neurotol. 2010 Feb;31(2):319-27.

The management of peripheral facial nerve palsy: "paresis" versus "paralysis" and
sources of ambiguity in study designs.

Linder TE, Abdelkafy W, Cavero-Vanek S.

Department of Otorhinolaryngology-Head & Neck Surgery, Kantonsspital Luzern,
Switzerland. thomas.linder@ksl.ch

OBJECTIVE: Conservative management of idiopathic or herpetic acute peripheral
facial palsy (herpes zoster oticus, HZO) often leads to a favorable outcome.
However, recent multicenter studies have challenged the necessity of antivirals. 
Whereas large numbers of patients are required to reveal statistical differences 
in a disease with an overall positive outcome, surprisingly few studies
differentiate between patients with paresis and paralysis. Analyzing our own
prospective cohort of patients and reviewing the current literature on
conservative treatment of Bell's palsy and HZO, we reveal the importance of
initial baseline assessment of the disease course to predict the outcome and to
validate the impact of medical treatment options. STUDY DESIGN AND DATA SOURCE:
Prospective analysis of consecutive patients referred to 2 tertiary referral
centers and research on the Cochrane Library for current updates of their
previous reviews and search of MEDLINE (1976-2009) for randomized trials on
conservative treatment of acute facial palsy were conducted. METHODS: One hundred
ninety-six patients with Bell's palsy or HZO were followed up prospectively until
complete recovery or at least for 12 months. The numeric Fisch score (FS) was
used to classify facial function, and patients were separated between incomplete 
palsy (=paresis) and complete paralysis. Electroneuronography (ENoG) was used to 
further subdivide patients with paralysis. The treatment protocol was independent
of the ongoing investigation including prednisone and valacyclovir in most
patients. A total of 250 previous studies on facial palsy outcome were evaluated 
regarding their distinction between different severity scores at baseline and its
impact on treatment outcome. Trials not making the distinction between paresis
and paralysis at baseline and with an insufficient follow-up of less than 12
months were excluded. RESULTS: In the Bell's and HZO paresis group, all except 1 
patient recovered completely, most of them within 3 months, independent of the
treatment regimen. In the Bell's paralysis group, 38 patients (70%) recovered
completely after 1 year, including 94% of patients with a denervation by ENoG of 
less than 90%. Thirty percent of Bell's paralysis patients recovered
incompletely, revealing the worst outcome in patients with a 100% denervation on 
ENoG. None of the 4 patients with HZO and ENoG denervation of more than 90%
recovered to normal facial function. We found a highly significant difference
regarding the time course and final outcome in patients with incomplete palsies
versus total paralysis; however, only 3 of 250 studies make this distinction.
CONCLUSION: The time course for improvement and the extent of recovery is
significantly different in patients presenting with an incomplete facial nerve
paresis compared with patients with a total paralysis. Whereas the term "palsy"
includes both entities, the term "paralysis" should only be used to describe
total loss of nerve function. Patients with incomplete acute Bell's palsy
(paresis) should start to improve their facial function early (1-2 wk after
onset) and are expected to recover completely within 3 months. These patients do 
not benefit from antiviral medications and most likely do not profit from
systemic steroids. Mixing patients with different severity of palsies will always
lead to controversial results.

PMID: 20009779 [PubMed - in process]


63. Rinsho Ketsueki. 2009 Nov;50(11):1641-6.

Successful treatment with autologous peripheral blood stem cell transplantation
for acquired immunodeficiency syndrome (AIDS)-related malignant lymphoma.

NAGAI Y, MORI M, INOUE D, KIMURA T, SHIMOJI S, TOGAMI K, TABATA S, MATSUSHITA A, 
NAGAI K, Imai Y, Takafuta T, Takahashi T.

Departments of Hematology and Clinical Immunology, Kobe City Medical Center
General Hospital.

A 62-year-old man was diagnosed with human immunodeficiency virus (HIV) infection
while suffering from recurrent herpes zoster infection. Laboratory examination
revealed CD4(+) lymphocyte count 16 cells/mul and HIV loading 150,000 copies/ml
at presentation. In addition, he had multiple lymph node swelling. Histologic
diagnosis of a biopsied lymph node was diffuse, large, B cell-type malignant
lymphoma. The karyotype of the lymphoma cells was t(8;14)(q24;q32), which was
confirmed by G-banding and fluorescent in situ hybridization. Positron emission
tomography (PET)-combined CT scanning revealed systemic extranodal tumors
involving the gastrointestinal tract, pancreas, and bone marrow. The clinical
stage of the lymphoma was IVB and the international prognosis index was
categorized as high. Complete remission (CR) of the lymphoma was obtained after 2
courses of CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone)
chemotherapy and 4 subsequent courses of rituximab-combined CHOP (R-CHOP). Highly
active antiretroviral therapy (HAART) was started at the initiation of CHOP.
Because of the poor prognosis of AIDS-related lymphoma, he received autologous
peripheral blood stem cell transplantation with the MEAM protocol (ranimustine,
etoposide, cytarabine, melphalan) as a conditioning procedure without a severe
infectious episode. He remains in CR 24 months after the transplantation.

PMID: 20009441 [PubMed - indexed for MEDLINE]


64. J Natl Cancer Inst. 2010 Jan 6;102(1):47-53. Epub 2009 Dec 9.

Dermatologic infections in cancer patients treated with epidermal growth factor
receptor inhibitor therapy.

Eilers RE Jr, Gandhi M, Patel JD, Mulcahy MF, Agulnik M, Hensing T, Lacouture ME.

Department of Dermatology, Northwestern University Feinberg School of Medicine,
Chicago, IL 60611-2941, USA.

BACKGROUND: Patients treated with epidermal growth factor receptor inhibitors
(EGFRIs) frequently experience dermatologic toxic effects. Whereas the impact of 
these effects on quality of life and EGFRI dosing has been described, their
impact on physical health has not been ascertained. We examined the prevalence of
infections that complicate dermatologic toxic effects of EGFRIs. METHODS: We used
retrospective chart review methods to analyze 221 patients who were treated in
the Skin and Eye Reactions to Inhibitors of EGFR and Kinases clinic, a referral
clinic for dermatologic toxic effects of cancer therapies. We reviewed results of
bacterial cultures, histopathologic assessment of biopsy samples, and
immunohistochemical staining of skin specimens for viral pathogens that were
recorded in the patients' medical records. Associations between patient
demographic and treatment characteristics and the development of infections were 
examined using the Fisher exact test. All statistical tests were two-sided.
RESULTS: Eighty-four (38%) of the 221 patients showed evidence of infection at
sites of dermatologic toxic effect. Fifty (22.6%) of the 221 patients had
cultures positive for Staphylococcus aureus, and 12 (5.4%) of the 221 patients
cultured positive for methicillin-resistant S aureus. Less frequent infections
included herpes simplex (3.2%), herpes zoster (1.8%), and dermatophytes (10.4%). 
The seborrheic region was the most prevalent site of infection, and patients with
leukopenia had higher risk for infection than patients who did not have
leukopenia (P = .005). Demographic factors and associated treatments were not
associated with the occurrence of a dermatologic infection (P > or = .05).
CONCLUSIONS: Patients with dermatologic toxic effects following treatment with
EGFRIs have a high prevalence of cutaneous infections. Most notably, bacterial
infections developed at sites previously affected by dermatologic toxic effects, 
with leukopenic patients being at greater risk.

PMID: 20007525 [PubMed - indexed for MEDLINE]


65. Transplant Proc. 2009 Dec;41(10):4169-71.

Characteristics of long-term immunosuppressive therapy in chinese pediatric renal
transplant patients: a single-center experience.

Yang S, Wu Z, Wu W, Lin W, Xu T, Cai J, Wang Q, Liao L, Tan J.

Transplant Center, Fuzhou General Hospital, Fuzhou, China.

We performed this study to investigate the trend and characteristics of various
immunosuppressive regimens as well as their efficacy and safety for long-term
survival of Chinese pediatric renal allograft recipients. METHODS: Thirty-four
patients who underwent kidney transplantation between January 1985 and July 2002 
had >/=5 years follow up. We retrospectively reviewed the baseline
characteristics, patient and kidney survival rates, renal function,
immunosuppressive regimens, drug levels, and adverse effects of immunosuppressive
medications. RESULTS: The 1-, 3-, and 5-year recipient versus graft survival
rates were 100% and 97.1%; 91.2% and 88.2%; 85.3% and 82.4%, respectively. The
proportions of patients treated with cyclosporine- or tacrolimus-based
immunosuppressive regimen at these times were 48.5%/51.5%; 60.0%/40.0%; and
53.6/46.4%. There were no significant differences in the dosages and drug levels 
after 1 year (P > .05). The proportions of azathioprine versus mycophenolate
mofetil adjunctive therapy were 21.3/78.8%; 23.3%/70%; and 32.1%/60.7%,
respectively. Forty percent of the surviving recipients developed complications, 
including hypertension, hyperlipidemia, gingival hyperplasia, hirsutism, liver
dysfunction, herpes zoster, diabetes mellitus or cataracts. CONCLUSIONS:
Cyclosporine or tacrolimus, plus mycophenolate mofetil or azathioprine, and
prednisone triple therapies showed promising long-term results with similar
efficacy and safety in pediatric renal recipients. Periodic drug level monitoring
is required to facilitate individualization of immunosuppressive regimens. Drug
doses and levels differed markedly from non-Chinese patients because of the
ethnic discrepancy.

PMID: 20005361 [PubMed - in process]


66. J Card Surg. 2010 Jan-Feb;25(1):28-9. Epub 2009 Nov 30.

Herpes zoster following saphenous venectomy for coronary bypass surgery.

Sachdeva S, Prasher P.

Department of Dermatology, Prasher Eye and Skin Care Centre, Ludhiana, India.
siloniederm@yahoo.com

PMID: 20002233 [PubMed - in process]


67. Clin Infect Dis. 2010 Jan 1;50(1):121-2.

High serum cholesterol levels are associated with herpes zoster infection after
heart transplantation.

Del Pozo JL, van de Beek D, Mandrekar JN, Daly RC, McGregor CG, Azanza JR, Patel 
R.

Comment on:
    Clin Infect Dis. 2009 Mar 15;48(6):745-55.

PMCID: PMC2803068 [Available on 2011/1/1]
PMID: 20001524 [PubMed - in process]


68. Adv Nurse Pract. 2008 Dec;16(12):47-9.

Herpes zoster alert. Prevent shingles with vaccination and awareness.

Carcio H.

Health and Continence Institute, Deerfield, Massachusetts, USA.

PMID: 19999464 [PubMed - indexed for MEDLINE]


69. Acta Derm Venereol. 2009 Nov;89(6):612-6.

Epidemiological features and costs of herpes zoster in Taiwan: a national study
2000 to 2006.

Jih JS, Chen YJ, Lin MW, Chen YC, Chen TJ, Huang YL, Chen CC, Lee DD, Chang YT,
Wang WJ, Liu HN.

Department of Dermatology, National Yang Ming University, Department of
Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.

To analyse the epidemiological characteristics and related costs of herpes zoster
in Taiwan, a nationally representative cohort of 1,000,000 individuals from the
National Health Insurance register was followed up from 2000 to 2006 and their
claims data analysed. Overall, 34,280 patients were diagnosed with zoster
(incidence 4.89/1000 person-years) and 2944 patients (8.6%) developed
post-herpetic neuralgia 3 months after the start of the zoster rash (incidence
0.42/1000 person-years). People with older age, diabetes, and immunocompromising 
conditions were at higher risk of developing zoster and post-herpetic neuralgia. 
The overall hospitalization rate for zoster was 16.1 cases per 100,000
person-years. The cost for each home care case and per hospitalized case were
approximately 53.30 euro and 1224.70 euro, respectively. Further research into
the cost-effectiveness of zoster vaccine is needed.

PMID: 19997693 [PubMed - in process]


70. Zhongguo Zhen Jiu. 2009 Nov;29(11):887-90.

[Observation on therapeutic effect of electroacupuncture at Jiaji (EX-B 2)
combined with blood-letting and cupping on herpes zoster]

[Article in Chinese]

Liu YN, Zhang HX, Huang GF, Zou R, Wei W.

Department of Acupuncture and Moxibustion, Wuhan Hospital of Integrated Chinese
and Western Medicine, Wuhan 430022, China. shuiyueliang813@163.com

OBJECTIVE: To compare the therapeutic effect differences between
electroacupuncture at Jiaji (EX-B 2) combined with blood-letting plus cupping and
western medicine therapy. METHODS: Fifty-three cases were randomly divided into
an observation group (n=31) and a control group (n=22). The observation group was
treated by electroacupuncture at Jiaji (EX-B 2) combined with blood-letting with 
a plum-blossom needle at the affected parts plus cupping, once each day. The
control group was treated by oral administration of Valaciclovir Hydrochlordide, 
Indomethacin, Vitamin B1 and Vitamin B12. RESULTS: The cured and markedly
effective rate of 96.8% in the observation group was better than that of 81.8% in
the control group (P < 0.05), and improvements of pain, pruritus, burning
sensation and sleep in the observation group were superior to those of the
control group (all P < 0.01). CONCLUSION: Electroacupuncture at Jiaji (EX-B 2)
combined with blood-letting and cupping is a better therapy for herpes zoster and
its therapeutic effect is better than that of routine western medicine therapy.

PMID: 19994687 [PubMed - indexed for MEDLINE]


71. J Oncol Pharm Pract. 2009 Dec 4. [Epub ahead of print]

Prophylactic antivirals may be helpful in prevention of varicella-zoster virus
reactivation in myeloma, but are they safe?

Dasanu CA, Alexandrescu DT.

Department of Hematology-Oncology, Saint Francis Hospital and Medical Center.

Purpose. Retrospective analysis of two recent multiple myeloma (MM) clinical
trials suggested that the use of bortezomib may be associated with an increased
incidence of herpes zoster infections. Therefore, prophylactic use of antivirals 
has been advocated by some authors. This article explores the potential risks and
pitfalls linked to routine acyclovir prophylaxis in bortezomib-treated
MM.Summary. Use of antivirals can be associated with important nephro- and
neurotoxicity. The nephrotoxicity induced by MM itself and its supportive
therapies, superimposed to aging and inherent immunosuppression in myeloma, makes
the development of renal impairment even more likely. On the other hand, sensory 
neuropathy is known to occur both during myeloma progression and in the setting
of bortezomib therapy. Furthermore, preexisting nephropathy in MM patients can
contribute to the occurrence of serious neurologic toxicity with acyclovir.
CONCLUSIONS: /B>. Long-term acyclovir prophylaxis in MM patients treated with
bortezomib may cause severe renal and neurological toxicity. Prevention of these 
complications can be achieved through either withholding of the antivirals or a
very close monitoring of both neurologic status and renal function in this
patient population. This highlights the importance of both clinician's and
pharmacist's involvement in optimization of myeloma patient care.

PMID: 19965947 [PubMed - as supplied by publisher]


72. Rev Prat. 2009 Nov 20;59(9):1287-93.

[Herpesvirus infections of the immunocompetant child and adult]

[Article in French]

Vitrat-Hincky V, Brion JP.

Clinique de maladies infectieuses, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 
9, France. vhinckyvitrat@chu-grenoble.fr

PMID: 19961091 [PubMed - indexed for MEDLINE]


73. Can J Neurol Sci. 2009 Nov;36(6):787-8.

MRI changes with acute shingles.

Khu KJ, Bernstein M.

Division of Neurosurgery, University of Toronto, Toronto Western Hospital,
Toronto, Ontario, Canada.

PMID: 19960763 [PubMed - indexed for MEDLINE]


74. Pediatr Infect Dis J. 2009 Dec 2. [Epub ahead of print]

Risk Factors of Herpes Zoster Among Children Immunized With Varicella Vaccine:
Results From a Nested Case-Control Study.

Tseng HF, Smith N, Marcy SM, Sy LS, Chao CR, Jacobsen SJ.

From the *Department of Research and Evaluation, Southern California Permanente
Medical Group, Kaiser Permanente, Pasadena, CA; and daggerHarbor-UCLA Medical
Center, UCLA Center for Vaccine Research, Torrance, CA.

BACKGROUND:: Previous studies of varicella-zoster virus reactivation in children 
have provided little information on potential risk factors. The aim of this study
was to investigate the effects of race, chronic medical conditions and
treatments, and recent vaccination, on the risk of herpes zoster (HZ) in children
vaccinated with one dose of varicella vaccine. METHODS:: Case subjects were
identified from a cohort of subjects who were members of the Southern California 
Kaiser Permanente Health Plan and received primary immunization with a
single-antigen live varicella vaccine at age </=12 years from 2002 to 2008.
Control subjects free of HZ during the study period were matched at a 5:1 ratio
to each case subject on date of birth and sex. Race information was obtained from
membership files, health records, and phone interview. Immunization history,
medical history, and health care utilization were identified from Southern
California Kaiser Permanente Health Plan electronic records. RESULTS:: During
this time, 122 children were diagnosed with HZ. With adjustment for the number of
hospitalizations, outpatient visits, and length of time between vaccination with 
varicella vaccine and the onset of HZ, Black children were at lower risk of
developing HZ than were White (OR=0.41, 95% CI=0.17-0.98) and Asian children
(OR=0.30, 95% CI=0.11-0.84). CONCLUSIONS:: These data suggest that the racial
differences in the risk of developing HZ seen in adults are manifest in children 
as well. As children are not subject to the majority of factors hypothesized to
underlie HZ in adults and as this study was conducted in a setting which affords 
equal access to health care, it is possible that genetic variation may explain
some portion of varicella-zoster virus reactivation.

PMID: 19952977 [PubMed - as supplied by publisher]


75. J Neuroophthalmol. 2009 Dec;29(4):325-37.

Complete unilateral ophthalmoplegia in herpes zoster ophthalmicus.

Sanjay S, Chan EW, Gopal L, Hegde SR, Chang BC.

Department of Ophthalmology and Visual Sciences, Alexandra Hospital, Singapore.
sanjay_s@alexhosp.com.sg

Based on a review of 20 well-documented cases reported in the English literature 
between 1968 and 2008, herpes zoster ophthalmicus (HZO) may rarely be associated 
with complete unilateral ophthalmoplegia, defined here as impaired ocular
ductions in all 4 directions within 3 months of onset of manifestations of HZO.
Ophthalmoplegia occurred equally in immune-competent and immune-incompetent
individuals. HZO preceded ophthalmoplegia in 75% by a mean interval of 9.5 days
and a range of 2 to 60 days, occurred simultaneously with ophthalmoplegia in 20%,
and followed by 2 days the onset of ophthalmoplegia in only 5%. Concurrent
conjunctival inflammation, keratitis, or anterior uveitis was present in 90%.
Lumbar puncture showed features of aseptic meningitis in 88%, slightly more than 
the 40%-50% found in patients with HZO without ophthalmoplegia. On orbit/brain
imaging, abnormal enlargement of the extraocular muscles was present in 33%, and 
orbital soft tissue swelling was present in 17%. Enhancement of ocular motor
cranial nerves was not reported. Complete or near-complete resolution of
ophthalmoplegia occurred in 65% within a range of 2 weeks to 1.5 years (mean 4.4 
months). A single autopsy report described granulomatous angiitis of the meninges
and large vessels in the anterior cerebral circulation, as well as periaxial
infarction in the optic nerve, pons, and medulla but without viral inclusion
bodies or antigen. Unsettled issues are whether the pathogenesis is direct viral 
invasion or an immune reaction to the virus, whether the impaired ocular ductions
are based on myopathic or neuropathic injury, whether there are predisposing
factors to the combination of HZO and complete ophthalmoplegia, and whether
treatment is effective.

PMID: 19952908 [PubMed - indexed for MEDLINE]


76. J Occup Environ Med. 2009 Dec;51(12):1447-54.

Occupational exposures and Hodgkin Lymphoma: Canadian case-control study.

Karunanayake CP, Singh GV, Spinelli JJ, McLaughlin JR, Dosman JA, McDuffie HH,
Pahwa P.

Canadian Centre for Health and Safety in Agriculture, College of Medicine,
University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

OBJECTIVE: The objective was to study the association between Hodgkin Lymphoma
(HL) and occupational exposures related to long-held occupation among males in
Canada. METHODS: A population-based case-control study of HL was conducted among 
males stratified by province of residence and age group. Conditional logistic
regression was used to fit statistical models. RESULTS: Several factors
independently increased the risk of HL. Ever exposure to ionizing radiation from 
uranium showed a significant association with HL. Men who had smoked cigarettes
for 25 years or more were the most likely to develop HL. Exposure to ultraviolet 
light and diagnosis with measles were negatively associated with HL, whereas
diagnosis with shingles increased the risk of HL. CONCLUSIONS: The higher risk of
developing HL may be associated with exposure to uranium ionizing radiation and
years of cigarette smoking.

PMID: 19952792 [PubMed - in process]


77. Zhonghua Er Ke Za Zhi. 2009 Jul;47(7):527-31.

[Establishment and clinical application of a new real time PCR assay for
simultaneous detection of human herpesvirus-6A and human herpesvirus-6B]

[Article in Chinese]

Cai MT, Wu YD, Wu XJ, Shang SQ.

Department of Central Laboratory, Children's Hospital Affiliated to the Medical
College, Zhejiang University, Hangzhou 310003, China.

OBJECTIVE: Human herpesvirus 6 (HHV-6) isolates are classified into two variants,
HHV-6A and HHV-6B, based on distinct genetic, antigenic and biological
characteristics. HHV-6 has been associated with encephalitis in children
recently. This study aimed to establish a real time PCR assay for simultaneous
detection of the two subtypes of HHV-6, and apply this new assay to children with
suspected encephalitis, then analyze the relationship between the infection with 
HHV-6 and encephalitis in children. METHOD: The universal primers and
variant-specific TaqMan probes were designed based on the highly conserved
sequences of the DNA polymerase gene (U38) of HHV-6. The 5' end of the probes for
HHV-6A and HHV-6B was labeled with the fluorescein reporter
tetrachloro-6-carboxyfluorescein and 6-carboxyfluorescein (6-FAM), separately,
while the 3' end were quenched with 6-carboxy-tetramethylrhodamine. The real time
PCR assay for simultaneous detection of HHV-6A and HHV-6B was established. Then, 
the plasmids of HHV-6A and -6B which were diluted by a 10-fold series from 10(9) 
to 10(0) copies/microl, together with controls were used for testing both
sensitivity and specificity of the real time PCR assay. The cerebrospinal fluid
(CSF) specimens from 445 cases of suspected encephalitis were tested with this
real time PCR and positive samples were then sequenced. RESULT: Both HHV-6A
(strain ZJ-159) and HHV-6B (strain GS) were positive on the real time PCR assay. 
There were no cross-reaction with herpes simplex virus type 1, type 2 (HSV-1,
HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus
(EBV), hepatitis B virus, Staphylococcus aureus, Mycoplasma pneumoniae and human 
DNA. A linear regression curve was obtained when plotting Ct values against the
log10 of the viral DNA input for both subtypes of HHV-6. The sensitivity
threshold was 10 copies/microl for the real time PCR. HHV-6 positive rate by the 
real time PCR assay was 4.72% (21/445), including 4 cases with HHV-6A infection, 
16 cases of HHV-6B infection and 1 case with mixed HHV-6A and HHV-6B infection.
The new PCR assay usually took 2 to 3 hours to provide results. CONCLUSION: This 
new real time PCR assay can simultaneously detect both subtypes of HHV-6, and
have high specificity and sensitivity. It will provide an early and sensitive
diagnosis of HHV-6 encephalitis in children.

PMID: 19951517 [PubMed - in process]


78. J Neurosurg Pediatr. 2009 Dec;4(6):528-31.

Going viral: fusiform vertebrobasilar and internal carotid aneurysms with
varicella angiitis and common variable immunodeficiency.

Daugherty WP, Clarke MJ, Cloft HJ, Lanzino GL.

Department of Neurosurgery, Mayo Clinic, 200 1st Street Southwest, Rochester,
Minnesota 55905, USA. daugherty.wilson@mayo.edu

Intracranial aneurysms in the pediatric population are relatively rare entities. 
Immunocompromised patients (often from HIV/AIDS or pharmacological
immunosuppression) represent a significant fraction of children with cerebral
aneurysms. One proposed mechanism of aneurysm formation in these patients is from
direct infection of the affected arteries. In this study, the authors report on a
case of a 14-year-old girl with common variable immunodeficiency with T-cell
dysfunction and a CSF polymerase chain reaction test positive for
varicella-zoster virus who underwent evaluation for carotid and basilar artery
fusiform aneurysms.

PMID: 19951038 [PubMed - indexed for MEDLINE]


79. Ophthalmologe. 2009 Dec;106(12):1074-82.

[Diagnostics and differential diagnosis of acute retinal necrosis]

[Article in German]

Pleyer U, Metzner S, Hofmann J.

Universitats-Augenklinik, Charite - Universitatsmedizin Berlin, Campus Virchow
Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
uwe.pleyer@charite.de

Multiple viruses have been identified as causative agents in acute retinal
necrosis (ARN). Retinal biopsies, analysis of intraocular antibody synthesis, and
polymerase chain reaction (PCR) have identified varicella zoster virus, herpes
simplex virus types 1 and 2, and cytomegalovirus. The differential diagnosis of
ARN includes atypical ocular toxoplasmosis, some white dot syndromes, and other
forms of retinal vasculitides such as Behcet's disease. Because therapeutic
intervention varies greatly in these acute situations, identification of the
causative agent is essential. Serology is rarely helpful, whereas analysis of
aqueous humor or vitreous samples provides clues to the etiology. Aqueous humor
antibody testing and PCR have demonstrated excellent diagnostic power with high
sensitivity and high specificity. This review is intended to provide an overview 
of the diagnostics and differential diagnosis of this rare but important
disorder.

PMID: 19949951 [PubMed - in process]


80. Future Neurol. 2009 Jan 1;4(1):103-117.

Clinical and molecular aspects of varicella zoster virus infection.

Gilden D, Nagel MA, Mahalingam R, Mueller NH, Brazeau EA, Pugazhenthi S, Cohrs
RJ.

A declining cell-mediated immunity to varicella zoster virus (VZV) with advancing
age or immunosuppression results in virus reactivation from latently infected
human ganglia anywhere along the neuraxis. Virus reactivation produces zoster,
often followed by chronic pain (postherpetic neuralgia or PHN) as well as
vasculopathy, myelopathy, retinal necrosis and cerebellitis. VZV reactivation
also produces pain without rash (zoster sine herpete). Vaccination after age 60
reduces the incidence of shingles by 51%, PHN by 66% and the burden of illness by
61%. However, even if every healthy adult over age 60 years is vaccinated, there 
would still be about 500,000 zoster cases annually in the United States alone,
about 200,000 of whom will experience PHN. Analyses of viral nucleic acid and
gene expression in latently infected human ganglia and in an animal model of
varicella latency in primates are serving to determine the mechanism(s) of VZV
reactivation with the aim of preventing reactivation and the clinical sequelae.

PMCID: PMC2782836
PMID: 19946620 [PubMed]


81. Joint Bone Spine. 2009 Dec;76(6):724-5.

Zoster cruralgia in a pregnant woman.

Daien CI, Cohen JD, Jorgensen C.

PMID: 19945328 [PubMed - indexed for MEDLINE]


82. Vaccine. 2010 Feb 3;28(5):1217-20. Epub 2009 Nov 26.

Disease burden and epidemiology of herpes zoster in pre-vaccine Taiwan.

Lin YH, Huang LM, Chang IS, Tsai FY, Lu CY, Shao PL, Chang LY; Varicella-Zoster
Working Group; Advisory Committee on Immunization Practices, Taiwan.

Department of Pediatrics, Cardinal Tien Hospital, Yong Ho Branch, Taiwan.

Herpes zoster, a common disease, has an important impact on the health of adults,
particularly the elderly, and the health system. This study evaluated the disease
burden and epidemiological characteristics of herpes zoster in Taiwan. Using
herpes zoster-related ICD-9-CM codes used on Taiwan's National Health Insurance
claims, we analyzed overall and age group differences in incidence,
complications, utilization of healthcare facilities, lengths of stay, and cost of
their medical care in Taiwan's population from 2000 to 2005. The overall annual
incidence of zoster was 4.97 cases per 1000 people, with women having a
significantly higher incidence than men (5.20 per 1000 vs. 4.72 per 1000,
p<0.001). The incidence increased stepwise with age, with 5.18 cases per 1000 in 
people 40-50 years old, 8.36 in those 50-60, 11.09 in those 60-70, and 11.77 in
those above 70 years old. The estimated lifetime risk of developing herpes zoster
was 32.2%. Zoster-related hospitalizations and medical cost per patient increased
with age. In conclusion, about two-thirds of Taiwan's zoster cases occur in
adults older than 40 years old and about one-third of the population would
develop zoster within their lifetime. (c) 2009 Elsevier Ltd. All rights reserved.

PMID: 19944790 [PubMed - indexed for MEDLINE]


83. Graefes Arch Clin Exp Ophthalmol. 2009 Nov 24. [Epub ahead of print]

Intraocular antibody synthesis against rubella virus and other microorganisms in 
Fuchs' heterochromic cyclitis.

Ruokonen PC, Metzner S, Ucer A, Torun N, Hofmann J, Pleyer U.

Augenklinik Charite-Universitatsmedizin Berlin (CVK) Germany, Augustenburger
Platz 1, 13353, Berlin, Germany, peter.ruokonen@charite.de.

INTRODUCTION: Fuchs' heterochromic cyclitis (FHC) is a common intraocular disease
of uncertain etiology that has recently been related to rubella virus (RV)
infection. METHODS: We investigated the synthesis of RV-specific IgG using
aqueous humor and serum samples from 63 consecutive patients with FHC. In
addition, intraocular immunoglobulin G production against herpes simplex virus
(HSV), varicella zoster virus (VZV), cytomegalovirus (CMV) and toxoplasma gondii 
was determined. In 20 patients, the detection of RV RNA was additionally
performed by RT-PCR on the E1 gene. Forty-six patients with HSV- and
VZV-associated uveitis, HLA B-27 positive anterior uveitis, and Posner-Schlossman
syndrome served as controls. RESULTS: Specific intraocular antibody synthesis
against RV was confirmed in all 63 FHC patients, whereas none of the 46 controls 
was positive for RV IgG. Interestingly, in 11 patients with positive RV IgG
synthesis, additional HSV (eight), VZV (one) and CMV (two) specific antibodies
could be detected. Only twice was viral RNA detectable by PCR in a patient with
FHC. CONCLUSIONS: In this largest reported series of FHC patients, we detected a 
strong association between FHC and intraocular antibody synthesis against rubella
virus. Furthermore, in 11 patients, it was possible to confirm an additional
intraocular antibody synthesis, in particular HSV. PCR-positive results in the
aqueous humor were exclusively obtained for RV. In contrast to other studies, the
RV genome could only be identified in two patients (10%).

PMID: 19937050 [PubMed - as supplied by publisher]


84. Pediatr Infect Dis J. 2009 Dec;28(12):1073-5.

Occult varicella.

Nikkels AF, Pierard GE.

Department of Dermatology, CHU du Sart Tilman, Liege, Belgium.
af.nikkels@chu.ulg.ac.be

BACKGROUND: Localized varicella has been associated with UV-exposure and skin
trauma. Varicella restricted to a pre-existent dermatitis is exceptional.
OBJECTIVES: The clinical features, cytohistologic and immunohistochemical
results, as well as serologic data of 6 patients with a sudden eruption of
vesicular and eroded lesions restricted to a pre-existent dermatitis are
presented. RESULTS: All patients (mean age: 8,3 years, range: 3-22) showed crops 
of a few to numerous vesicular lesions clustered on the restricted sites of
posttraumatic wound, perianal streptococcal dermatitis, dermatomycosis, allergic 
contact dermatitis, lichen sclerosus, and atopic foot dermatitis. All the Tzanck 
smears and 1 biopsy revealed multinucleated giant cells, consistent with herpes
simplex virus (HSV) or varicella zoster virus (VZV) infection.
Immunohistochemistry using specific anti-VZV antibodies (IE63 and gE) was
positive on all the smears and the biopsy, whereas HSV-I and HSV-II
immunolabeling was negative. VZV specific IgM+, IgG- EIA-based serology, and
positive VZV-specific IgM complement fixation test suggested primary VZV
infection. None had received varicella vaccine. None of the patients presented a 
history of varicella nor experienced breakthrough varicella. It was decided not
to administer antiviral treatment, as the varicella lesions remained localized
without any further skin extension and systemic signs. About 2 months later,
EIA-serology revealed positive VZV-IgG and negative IgM levels in 5/5 patients.
CONCLUSION: Some patients have varicella infection that remains hidden in a
pre-existent infectious and/or inflammatory dermatitis without ever presenting
full-blown chickenpox. The sudden occurrence of vesicular and/or ulcerated
lesions on a pre-existent dermatitis should prompt searching for a viral
infection.

PMID: 19935268 [PubMed - in process]


85. Dermatol Online J. 2009 Sep 15;15(9):16.

If at first you don't succeed: a difficult case of Linear IgA.

Krejci-Manwaring J, West DA, Tonkovic-Capin V.

We present a patient with Linear IgA who was both difficult to diagnose and
treat. Numerous biopsies were needed before a positive result could be returned. 
Trials of multiple systemic agents failed. Eventually, a second trial of dapsone 
was successful and well-tolerated. The case exemplifies the determination and
perseverance that is often required by both patient and physician in pursuit of
symptom relief.

PMID: 19931003 [PubMed - indexed for MEDLINE]


86. Clin Infect Dis. 2009 Dec 15;49(12):1838-47.

Infectious encephalitis in france in 2007: a national prospective study.

Mailles A, Stahl JP; Steering Committee and Investigators Group.

Collaborators: Bebear C, Bernillon P, Brouard C, de Broucker T, Cua E, Dabernat
H, Floret D, Lecuit M, Lina B, Lortholary O, Mailles A, Morand P, Michelet C,
Peigue-Lafeuille H, Pozetto B, Stahl JP, Vaillant V, Wolff M, Yazdanpanah Y,
Zeller H, Abboud P, Ahtoy P, Alloui C, Archimbaud C, Barroso B, Bernard L, Beuret
P, Billaud G, Blanc T, Bonnard-Gougeon M, Boutolleau D, Bretonniere C,
Bressollette-Bodin C, Bruneel F, Buisson M, Caramella A, Castan B, Cattaneo I,
Cazanave C, Chabrier S, Chadenat ML, Chambon M, Chavanet P, Chouchane M, Clavelou
P, Courant P, Cua E, DeBrabant F, Delablanchardie A, Demonclos H, Denes E,
Desprez P, de Wilde A, Dinh A, Durand F, Emeriaud G, Epaulard O, Favaretto G,
Ferrier A, Foulongne V, Fourrier F, Gaday V, Gaillat J, Gallet S, Gau M, Gazuy N,
Georges H, Gouarin S, Goubin P, Goudeau A, Granier AG, Grappin M, Gueit I, Guihot
A, Guillermet C, Guillet-Caruba C, Guimard Y, Hansmann Y, Harzic M, Henquell C,
Herrmann JL, Honnorat J, Houhou N, Jaulhac B, Join-Lambert O, Kossorotoff M,
Laudrault E, Laurent F, Laurichesse JJ, Lavoue S, Lazaro L, Legriel S, Lesens O, 
Level G, Mace M, Maisonneuve B, Makinson A, Marchandin H, Marignier S,
Martinez-Almoyna L, Marthelet P, Martinot M, Massenavette B, Maulin L, Mirand A, 
Misset B, Neuwirth C, Nicot F, Pacanowski J, Palcoux JB, Pavese P,
Peigue-Lafeuille H, Perez-Martin S, Perpoint T, Pestel-Caron M, Pouyau R, Prazuck
T, Prenki V, Rapp C, Regagnon C, Renie L, Rigal M, Roch N, Rogeaux O, Rogez S,
Santre C, Signori-Schmuck A, Simon F, Taimi A, Tayoro J, Terral D, Therby A,
Vuillemet F, Wolff M.

Institut de Veille Sanitaire, Saint-Maurice, Grenoble, France.
a.mailles@invs.sante.fr

Comment in:
    Clin Infect Dis. 2009 Dec 15;49(12):1848-50.

BACKGROUND: Encephalitis is associated with significant mortality and morbidity, 
but its cause remains largely unknown. We designed a national prospective study
in France in 2007 to describe patients with encephalitis, investigate the
etiologic diagnosis of encephalitis, and assess risk factors associated with
death. METHODS: Patients were enrolled by attending physicians according to case 
definition, and data were collected with a standardized questionnaire. The
etiologic diagnosis was investigated after a standardized procedure. Risk factors
associated with death during hospitalization were assessed by multivariate
logistic regression. RESULTS: A total of 253 patients with acute infectious
encephalitis from 106 medical units throughout France were included in the study.
Their ages ranged from 1 month to 89 years (median age, 54 years); 61% were male.
Cause of the encephalitis was determined in 131 patients (52%). Herpes simplex
virus 1 (42%), varicella-zoster virus (15%), Mycobacterium tuberculosis (15%),
and Listeria monocytogenes (10%) were the most frequently identified agents.
Twenty-six patients (10%, all adults) died, 6 of them with tuberculosis and 6
with listeriosis. Risk factors independently associated with death during
hospitalization identified by the multivariable analysis were age (odds ratio
[OR], 1.2; 95% confidence interval [CI], 1.0-1.4; for 5-year increase), cancer
(OR, 17; 95% CI, 2.3-122.6), immunosuppressive treatment before onset (OR, 24;
95% CI, 1.3-426.0), percentage of hospitalized patients receiving mechanical
ventilation (OR, 2.0; 95% CI, 1.4-3.0; for 10% increase), the etiologic agent,
coma on day 5 after admission (OR, 16; 95% CI, 2.8-92.3), and sepsis on day 5
after admission (OR, 94; 95% CI, 4.9-1792.2). CONCLUSIONS: Our prospective study 
provides an overview of the clinical and etiologic patterns of acute infectious
encephalitis in adults in France. Herpes simplex virus 1 remains the main cause
of encephalitis, but bacteria accounts for the highest case-fatality rates.

PMID: 19929384 [PubMed - indexed for MEDLINE]


87. Masui. 2009 Nov;58(11):1413-7.

[The efficacy of intravenous lidocaine for acute herpetic pain--placebo
controlled trial]

[Article in Japanese]

Fujii H, Fukushima T, Ishii M, Nagano Y, Kawanishi S, Watanabe Y, Kosogabe Y,
Kajgki H, Tokioka H.

Department of Anesthesia, Kajiki Hospital, Okayama 701-0136.

BACKGROUND: Acute herpetic pain (AHP) which is considered not only nociceptive
pain but also neuropathic pain, is often severe and intractable. Although there
have been reports of the efficacy of intravenous lidocaine (IVL) for neuropathic 
pain, the efficacy of lidocaine for AHP is not known. Therefore, the effect of
IVL for AHP was examined. METHODS: The study included 43 patients, who visited
our pain management office within 90 days after skin eruption of herpes zoster.
This study was a randomized, placebo-controlled design. In group A, a continuous 
infusion of saline 100 ml for 30 min was given followed by a continuous infusion 
of IVL 3 mg x kg(-1) for 30 min. In group B, IVL 3 mg x kg(-1) for 30 min was
given followed by saline 100 ml for 30 min. A pain relief score (PRS) was
assessed at the end of each infusion. RESULTS: In group A, PRS decreased
significantly with saline and decreased furthermore with IVL. In group B, PRS
decreased significantly with IVL and did not change with saline. A reduction of
PRS with IVL in group B was significantly greater than that with saline in group 
A. CONCLUSIONS: This study demonstrates that IVL has a significant analgesic
effect in patients with AHP.

PMID: 19928509 [PubMed - indexed for MEDLINE]


88. J Emerg Med. 2009 Nov 17. [Epub ahead of print]

Altered mental status from acyclovir.

Martinez-Diaz GJ, Hsia R.

Stanford University School of Medicine, Stanford, California.

Background: Acyclovir is widely used in the treatment of herpes virus infections,
particularly herpes simplex virus and varicella-zoster virus. Acyclovir, when
given promptly upon the start of a herpes zoster eruption, speeds healing and
diminishes acute pain. Objectives: Because acyclovir is a commonly used
medication, it is crucial for health providers to be aware of appropriate dosing 
as well as possible side effects. We present this case to increase awareness of
the potential for inappropriate dosing of acyclovir and the presentations of
patients with toxic effects. Case Report: We report the case of a 65-year-old man
with a past medical history significant for chronic kidney disease who presented 
to the Emergency Department with progressive confusion and ataxia over 2 days.
Thorough questioning in the patient's native language revealed that he had
recently started a medication for a "rash." Neither he nor his family knew the
name of the new medication; further investigation revealed it to be acyclovir.
Although other diagnoses were considered in the differential diagnosis for this
patient with altered mental status, he was treated for presumed acyclovir
toxicity and given prompt dialysis, upon which his symptoms resolved. Conclusion:
It is important for physicians to remember that even common medications such as
acyclovir can have serious side effects and complications. In this case, renal
dosing was not used in a patient on hemodialysis. Acyclovir must be renally dosed
and carefully monitored through drug level measurement in patients with limited
kidney function to prevent serious side effects, such as the neurological
sequelae demonstrated in this case report. Emergency physicians should be aware
of the potential for inappropriate dosing of this medication and the
presentations of patients with toxic effects.

PMID: 19926428 [PubMed - as supplied by publisher]


89. Ugeskr Laeger. 2009 Nov 9;171(46):3350-4.

[Herpes zoster-associated morbidity in children undergoing chemotherapy for acute
lymphoblastic leukaemia]

[Article in Danish]

Sorensen GV, Helgestad J, Rosthoj S.

Arhus Universitetshospital, Aalborg Sygehus, Arhus C, Denmark.
gittevs@hotmail.com

INTRODUCTION: Herpes zoster rarely occurs in healthy children, but may occur
frequently and may take a complicated course in children receiving chemotherapy. 
We aimed to assess morbidity from herpes zoster in children with acute
lymphoblastic leukemia (ALL). MATERIAL AND METHODS: Reviewing records, treatment 
and course of zoster eruptions were registered in a cohort of 67 children with
newly diagnosed ALL. Of these, 45 had had varicella at the time of diagnosis and 
15 contracted varicella or were vaccinated during the course of therapy. RESULTS:
Eleven children had a total of 17 eruptions while receiving chemotherapy. All
eruptions were treated with acyclovir, in eight cases intravenously, and in six
cases chemotherapy was interrupted. Cutaneous dissemination occurred in two
cases, visceral dissemination in none. One child had postherpetic trigeminal
neuralgia for two months. The eruption rate was higher among small children than 
among school-aged children (0.22 vs. 0.13 per year of chemotherapy) and was
related to the intensity of chemotherapy (0.30 per year of consolidation
treatment vs. 0.13 for maintenance therapy). Three children on prolonged
intensive chemotherapy had recurrent zoster episodes. CONCLUSION: Chemotherapy
causes zoster eruptions in approximately one quarter of children with ALL, and
with intensive protocols recurrent zoster can cause significant morbidity.
Attempts to improve immunity by vaccine boosting after attaining remission seems 
warranted.

PMID: 19925740 [PubMed - indexed for MEDLINE]


90. Curr Pharm Des. 2009;15(31):3644-55.

Insulin-degrading enzyme: structure-function relationship and its possible roles 
in health and disease.

Fernandez-Gamba A, Leal MC, Morelli L, Castano EM.

Fundacion Instituto Leloir and Instituto de Investigaciones Bioquimicas de Buenos
Aires, Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET),
Patricias Argentinas 435, Buenos Aires C1405BWE, Argentina.

Insulin-degrading enzyme (IDE) or insulysin is a highly conserved Zn(2+)
-dependent endopeptidase with an "inverted" HxxEH motif. In vivo, IDE contributes
to regulate the steady state levels of peripheral insulin and cerebral amyloid
beta peptide (Abeta) of Alzheimer's disease. In vitro, substrates of IDE include 
a broad spectrum of peptides with relevant physiological functions such as atrial
natriuretic factor, insulin-like growth factor-II, transforming growth
factor-alpha, beta-endorphin, amylin or glucagon. The recently solved crystal
structures of an inactive IDE mutant bound to four different substrates indicate,
in accordance with previous compelling biochemical data, that peptide backbone
conformation and size are major determinants of IDE recognition and substrate
selectivity. IDE-N and IDE-C halves contribute to substrate binding and may
rotate away from each other leading to open and closed conformers that permit or 
preclude the entry of substrates. Noteworthy, stabilization of substrate beta
strands in their IDE-bound form may explain the preference of IDE for peptides
with a high tendency to self-assembly as amyloid fibrils. These structural
requirements may underlie the capability of some amyloid peptides of forming
extremely stable complexes with IDE and raise the possibility of a dead-end
chaperone-like function of IDE independent of catalysis. Furthermore, the recent 
recognition of IDE as a varicella zoster virus receptor and its putative
involvement in muscle cell differentiation, steroid receptor signaling or
proteasome modulation suggest that IDE is a multi-functional protein with broad
and relevant roles in several basic cellular processes. Accordingly, IDE
functions, regulation or trafficking may partake in the molecular pathogenesis of
major human diseases and become potential targets for therapeutic intervention.

PMID: 19925417 [PubMed - indexed for MEDLINE]


91. J Virol. 2010 Feb;84(3):1616-24. Epub 2009 Nov 18.

Antibody to varicella-zoster virus immediate-early protein 62 augments allodynia 
in zoster via brain-derived neurotrophic factor.

Hama Y, Shiraki K, Yoshida Y, Maruyama A, Yasuda M, Tsuda M, Honda M, Takahashi
M, Higuchi H, Takasaki I, Daikoku T, Tsumoto T.

Department of Virology, University of Toyama, 2630 Sugitani, Toyama 930-0194,
Japan.

Varicella-zoster virus (VZV) expresses immediate-early protein 62 (IE62), and
zoster is associated with neuropathic pain. Brain-derived neurotrophic factor
(BDNF) is involved in the neuronal mechanism underlying pain hypersensitivity.
Zoster is associated with prodrome and the robust production of booster antibody 
to VZV. We hypothesized that the intrathecal production of antibody to IE62
cross-reacting with BDNF and the nerve injury by skin lesions may augment
allodynia in zoster by enhancing BDNF activity. One of three monoclonal
antibodies against the 268-556 peptide of IE62 recognized BDNF. Immunological
cross-reactivity between IE62 and BDNF and the effects of anti-IE62 monoclonal
antibody (anti-IE62 MAb) cross-reactivity with BDNF on BDNF activity in cultured 
neurons were examined. Anti-IE62 MAb and anti-BDNF MAbs recognized the 414-429
peptide of IE62 and the BDNF dimer. Anti-IE62 MAb significantly augmented
BDNF-related transcription in neurons and the morphological development of spinal
dorsal horn neurons. Sera from patients recognized IE62 and BDNF and enhanced
BDNF activity in neurons. The effect of anti-IE62 antibody on mechanical
allodynia was characterized by the threshold of allodynia using von Frey
filaments in a spinal nerve injury (SNI) in mice. The administration of anti-IE62
MAb to or immunization with cross-reacting IE62 protein to mice significantly
enhanced mechanical allodynia on the side with SNI but not on the uninjured side.
Anti-IE62 antibody augmented BDNF activity in neurons and allodynia in mice with 
SNI. The intrathecal production of anti-IE62 antibody augmenting BDNF activity
and peripheral nerve injury by zoster may participate in the pathogenesis of
allodynia in zoster.

PMCID: PMC2812341 [Available on 2010/8/1]
PMID: 19923188 [PubMed - indexed for MEDLINE]


92. J Cutan Pathol. 2009 Nov 17. [Epub ahead of print]

Skin metastasis: a pathologist's perspective.

Hussein MR.

Department of Pathology, Assir Central Hospital, Kingdom of Saudi Arabia.

Skin metastasis is defined as the spread of malignant cells from a primary
malignancy to the skin. It is one manifestation of systemic spread of cancer. The
tumor cells originate either from an internal malignancy or from a primary skin
cancer. This study presents a literature review concerning these issues as well
as this author's experience encountered throughout 19 years of surgical pathology
and dermatopathology practice. Several conclusions are evident. Generally, skin
metastases are encountered in 0.7-9% of all patients with cancer and as such the 
skin is an uncommon site of metastatic disease when compared to other organs.
There is usually a long-time lag between the diagnosis of the primary malignancy 
and the recognition of the skin metastases. However, these metastases may be the 
first indication of the clinically silent visceral malignancies. The regional
distribution of the skin metastasis, although not always predictable, is related 
to the location of the primary malignancy and the mechanism of metastatic spread.
The relative frequency of skin metastasis correlates with the type of primary
cancer, which occurs in each sex. For instance, lung and breast carcinomas are
the most common primaries that send skin metastasis in men and women,
respectively. The head and neck region and the anterior chest are the areas of
greatest predilection in men. The anterior chest wall and the abdomen are the
most commonly involved sites in women. Skin metastases usually appear as
non-specific groups of discrete firm painless nodules that emerge rapidly without
any explanation. They vary in size from so tiny as to be of 'miliary lesions' to 
as large as 'Hen's egg size'. Some skin metastasis may mimic specific
dermatological conditions such as cutaneous cyst, dermatofibroma, pyogenic
granuloma, hemangioma, papular eruptions, herpes zoster eruptions, rapidly
infiltrating plaques, alopecic patches, cellulitis and erysipelas.
Histologically, the skin metastases usually show features reminiscent of the
primary malignancy, but with variable degrees of differentiation. Molecularly,
skin metastasis is an organized, non-random and organ-selective process
orchestrated by interaction among several heterogeneous molecules, which are
largely unknown. Metastasis to the skin is often a pre-terminal event that
heralds poor outcome. Hussein MRA. Skin metastasis: a pathologist's perspective.

PMID: 19922483 [PubMed - as supplied by publisher]


93. J Anesth. 2009;23(4):605-8. Epub 2009 Nov 18.

Ultrasound-aided unilateral epidural block for single lower-extremity pain.

Yamauchi M, Kawaguchi R, Sugino S, Yamakage M, Honma E, Namiki A.

Department of Anesthesiology, Sapporo Medical University School of Medicine,
Chuo-ku, Sapporo, Japan.

We report an ultrasound-aided unilateral epidural block, employed in two
patients, to provide better analgesia and motor function for lower-extremity
pain. The patient in case 1 was a 72-year-old woman who suffered pain arising
from Herpes zoster rash on the left leg (the second lumbar nerve area). A
left-dominant continuous unilateral epidural block was performed to reduce her
pain. After confirming the L2/3 epidural space and needle direction using
ultrasound imaging, epidural cannulation was performed. Continuous infusion of 4 
ml h(-1) of 1% lidocaine through the epidural catheter eliminated the herpetic
pain in the left leg, maintaining motor function and normal sensation in her
right leg. The patient in case 2 was a 35-year-old man whose complaint was
postoperative pain in his left knee during passive movement. Dependent-side
(left-side) dominant ultrasound-aided continuous unilateral epidural block, the
same procedure as that used in case 1, was performed at the L3/4 intervertebral
space. His left knee pain was clearly reduced, with partial paralysis, but motor 
function in his right leg was completely normal during the continuous epidural
block with 4 ml h(-1) of 0.2% ropivacaine. Ultrasound imaging around the epidural
space facilitated effective unilateral epidural block for single lower-extremity 
pain in both patients. This technique could decrease possible side effects and
improve patient satisfaction during continuous nerve block by maintaining motor
function and sensation in the nondependent side.

PMID: 19921377 [PubMed - indexed for MEDLINE]


94. Reg Anesth Pain Med. 2009 Sep-Oct;34(5):514-21.

Evidence-based case report: the prevention and management of postherpetic
neuralgia with emphasis on interventional procedures.

Benzon HT, Chekka K, Darnule A, Chung B, Wille O, Malik K.

Department of Anesthesiology, Northwestern University Feinberg School of
Medicine, Chicago, IL 60611, USA. hbenzon@nmff.org

OBJECTIVE: A patient with postherpetic neuralgia (PHN) did not respond to
medications, either singly or in combination, or to intrathecal
methylprednisolone but responded to intrathecal alcohol. This evidenced-based
case management article evaluates and grades the evidence for the prevention and 
treatment of PHN. METHODS: A search of published English-language studies on the 
prevention and treatment of PHN was made. RESULTS: Randomized clinical studies
showed the efficacy of antiviral agents in the prevention of PHN and the use of
anticonvulsants, antidepressants, opioids, and Lidoderm patch in the treatment of
PHN (level A evidence). The role of epidural local anesthetic and steroid
injections in preventing PHN has not been completely established (level B
evidence). Intrathecal steroid injections and topical capsaicin may be effective 
in PHN (level B evidence). No randomized controlled study supports the usefulness
of spinal cord stimulation and intrathecal alcohol. CONCLUSIONS: Postherpetic
neuralgia should be managed pharmacologically. If not effective, intrathecal
steroid injections or nerve blocks may be tried. Spinal cord stimulation or
intrathecal alcohol should be used only as a last resort.

PMID: 19920429 [PubMed - indexed for MEDLINE]


95. J Infect Dis. 2009 Dec 15;200(12):1901-6.

Distribution of herpes simplex virus type 1 and varicella zoster virus in ganglia
of the human head and neck.

Richter ER, Dias JK, Gilbert JE 2nd, Atherton SS.

Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta, 
Georgia 30912, USA.

The distribution of the neurotropic alphaherpesviruses-herpes simplex virus type 
1 (HSV-1) and type 2 (HSV-2) and varicella zoster virus (VZV)-was determined in
autonomic and sensory ganglia of the head and neck obtained from formalin-fixed
human cadavers. HSV-1 and VZV DNA were found in 18 of 58 and 16 of 58 trigeminal,
23 of 58 and 11 of 58 pterygopalatine, 25 of 60 and 14 of 60 ciliary, 25 of 48
and 11 of 48 geniculate, 15 of 50 and 8 of 50 otic, 14 of 47 and 4 of 47
submandibular, 18 of 58 and 10 of 58 superior cervical, and 12 of 36 and 1 of 36 
nodose ganglia, respectively. HSV-2 was not detected at any site. Viral DNA
positivity and location were independently distributed among autonomic and
sensory ganglia of the human head and neck.

PMCID: PMC2782560 [Available on 2010/12/15]
PMID: 19919304 [PubMed - indexed for MEDLINE]


96. Cases J. 2009 Sep 1;2:6299.

A 46-year-old female presenting with worsening headache, nuchal rigidity and a
skin rash in varicella zoster virus meningitis: a case report.

Kushawaha A, Mobarakai N, Tolia J.

Department of Medicine, Division of Infectious Diseases, Island University
Hospital 475 Seaview Ave., Staten Island, NY 10305 USA.

Varicella zoster virus causes two distinct clinical diseases. Varicella is the
primary infection and results from exposure of a person susceptible to the virus.
The virus remains latent in cranial nerve ganglia, dorsal root ganglia, and
autonomic ganglia along the entire neuraxis. Years later, in association with a
decline in cell-mediated immunity in the elderly and immuno-compromised,
varicella zoster virus reactivates and can cause a wide range of neurologic
disease, including herpes zoster ('shingles'), postherpetic neuralgia,
vasculopathy, myelopathy, retinal necrosis, cerebellitis, and zoster sine
herpete. Herpes zoster is associated with numerous neurologic complications and
varied presentations. Patients who have a dermatomal distribution of varicella
zoster virus and who have headaches should be considered to have VZV meningitis. 
Virologic confirmation requires testing the cerebrospinal fluid for varicella
zoster virus deoxyribonucleic acid via polymerase chain reaction. The application
of polymerase chain reaction to the cerebrospinal fluid can be used to detect
varicella zoster virus deoxyribonucleic acid and, therefore, infections of the
central nervous system. We present a case report of a 46-year-old female who
initially presented with worsening headache, nuchal rigidity, fever, and a skin
rash, who was subsequently found to have varicella zoster meningitis.

PMCID: PMC2769281
PMID: 19918571 [PubMed - in process]


97. J Med Case Reports. 2009 Sep 14;3:9134.

Varicella-zoster virus reactivation from multiple ganglia: a case report.

Hashemilar M, Ghabili K, Shoja MM, Savadi-Oskouei D, Keyvani H.

INTRODUCTION: Simultaneous involvements of multiple cranial nerve ganglia
(geniculate ganglion and peripheral ganglia of cranial nerves VIII, IX and X) by 
varicella-zoster virus and its subsequent activation may result in the
characteristic eruptions of herpes zoster cephalicus. Coexistence of facial palsy
and involvement of upper cervical dermatomes by varicella-zoster virus is quite
rare. CASE PRESENTATION: Here, we report a 71-year-old Iranian man with
involvement of multiple sensory ganglia (geniculate ganglion and upper dorsal
root ganglia) by varicella-zoster virus. He presented with right-sided facial
weakness along with vesicular eruptions on the right side of his neck, and second
and third cervical dermatomes. CONCLUSION: The present case is an example of
herpes zoster cephalicus with cervical nerve involvement. Although resembling
Ramsay Hunt syndrome with presence of facial nerve paralysis and accompanying
vesicles, involvement of cervical dermatomes is not a feature of the classic
Ramsay Hunt syndrome.

PMCID: PMC2767152
PMID: 19918290 [PubMed - in process]


98. Transplant Proc. 2009 Nov;41(9):3959-61.

Pneumonia due to varicella-zoster virus reinfection in a renal transplant
recipient.

Sato A, Amada N, Kikuchi H, Fukumori T, Haga I, Takahashi Y.

Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan.
ake1215@mail.tains.tohoku.ac.jp

Varicella pneumonia is one of the serious complications of primary varicella
zoster virus (VZV) infection in adults. A 36-year-old woman with end-stage renal 
disease underwent renal transplantation from a living donor in 1998, receiving
immunosuppressive treatment with cyclosporine, mycophenolate mofetil, and
methylprednisolone. She had a history of VZV infection during childhood. The
patient developed an intractable cough on December 10, 2006, but there were no
abnormalities in the laboratory data or chest radiograph for several weeks. On
January 1, 2007, she was admitted to our hospital with cutaneous vesicles
covering the entire body. We learnt that when her symptoms developed, her son was
diagnosed with varicella. The chest radiograph at this stage showed a diffuse
miliary pattern in the entire lung field. We started intravenous administration
of acyclovir. VZV antigen was detected in the cutaneous lesions and VZV antibody 
in the serum after the start of these treatments, so we continued to administer
acyclovir for 18 days. The cutaneous lesions healed and the pneumonia improved
based on the chest radiograph. She was discharged from the hospital on January
19, 2007. In conclusion, this report documents VZV reinfection in a transplant
patient.

PMID: 19917424 [PubMed - indexed for MEDLINE]


99. Am J Ophthalmol. 2010 Feb;149(2):214-220.e3. Epub 2009 Nov 11.

Late varicella-zoster virus dendriform keratitis in patients with histories of
herpes zoster ophthalmicus.

Hu AY, Strauss EC, Holland GN, Chan MF, Yu F, Margolis TP.

Ocular Inflammatory Disease Center, Jules Stein Eye Institute and the Department 
of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles,
California, USA.

PURPOSE: To describe the characteristics and course of late varicella-zoster
virus (VZV) dendriform keratitis in patients with histories of herpes zoster
ophthalmicus (HZO); to describe responses of corneal lesions to antiviral
treatment; and to investigate risk factors for recurrence. DESIGN: Retrospective 
case series. METHODS: Included were patients known to have 1 or more episodes of 
dendriform lesions beginning at least 2 weeks after HZO in 2 academic practices. 
Epithelial lesions were evaluated for the presence of VZV DNA by a polymerase
chain reaction assay. Demographic, medical, and ophthalmic data were collected
for each episode. Responses to treatment with antiviral medications were
evaluated. Cumulative risk of recurrence was determined using Kaplan-Meier
analysis; potential risk factors for recurrence (age, systemic disease, lesion
characteristics, corticosteroids) were evaluated using univariate Cox
proportional hazard models. RESULTS: We identified 20 patients (14 women; median 
age, 65 years) who met inclusion criteria. Dendriform lesions were pleomorphic
with thickened, opaque epithelium. Seven patients had systemic diseases
characterized by altered immune function. VZV DNA was identified in 15 of 16
cases tested, and all lesions responded to antiviral therapy. The 1-year
incidence of first recurrence was 95.8 lesions per 100 person-years of follow-up.
Patients had multiple recurrences, but risk of recurrence appeared to decrease
over time. No statistically significant risk factors for recurrence were
identified. CONCLUSIONS: Late dendriform lesions associated with HZO are foci of 
productive VZV infection. Lesions can be treated effectively with topical or
systemic antiviral agents. Patients can have multiple recurrences of dendriform
lesions despite treatment. Copyright (c) 2010 Elsevier Inc. All rights reserved.

PMID: 19909942 [PubMed - indexed for MEDLINE]


100. Pharmacoeconomics. 2009;27(12):1005-16. doi: 10.2165/11314000-000000000-00000.

Willingness to pay for a QALY based on community member and patient preferences
for temporary health states associated with herpes zoster.

Lieu TA, Ray GT, Ortega-Sanchez IR, Kleinman K, Rusinak D, Prosser LA.

Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and
Harvard Medical School, Boston, Massachusetts 02215, USA.
tracy_lieu@harvardpilgrim.org

BACKGROUND AND OBJECTIVES: A clear sense of what society is willing to pay for a 
QALY could enhance the usefulness of cost-effectiveness analysis as a field.
Scant information exists on willingness to pay (WTP) for a QALY based on direct
elicitation of preferences from community members or patients. We had the
opportunity to evaluate WTP per QALY using data from a survey on temporary health
outcomes related to herpes zoster. Our aims were to (i) describe how much
community members are willing to pay to save a QALY based on scenarios describing
temporary health states; (ii) evaluate how WTP per QALY varies based on
experience with the disease being described and with demographic variables; and
(iii) evaluate how the duration and intensity of pain in a scenario influences
WTP per QALY. METHODS: Community members drawn from a nationally representative
survey research panel (n = 478) completed an Internet-based survey using time
trade-off (TTO) and WTP questions to value a series of scenarios that described
herpes zoster cases of varying pain intensity (on a scale of 0-10) and duration
(30 days to 1 year). Patients with shingles (n = 354) or postherpetic neuralgia
(PHN; n = 120) [defined as having symptoms for 90 days or more] from two large
healthcare systems completed telephone interviews with similar questions. Mean
and median WTP per QALY values were calculated by dividing the WTP amount by the 
discounted time traded for each scenario. Responses with a WTP value of more than
zero and a TTO value of zero (which would have resulted in an undefined value)
were excluded. TTO values were discounted by 3% per year. WTP per QALY means were
calculated after trimming the top and bottom 2.5% of responses. Multivariate
analyses were conducted using generalized linear mixed models that assumed a
negative binomial distribution. RESULTS: Among all respondents, the WTP per QALY 
ranged from a median of $US7000 to $US11,000 and a trimmed mean of $US26 000 to
$US45,000 (year 2005 values), depending on the scenario described. WTP per QALY
values varied significantly with respondent characteristics, as well as among
respondents with similar characteristics. In multivariate analyses, the mean WTP 
per QALY was higher among respondents who were younger, male or had higher
educational or income levels. After adjusting for these demographic variables,
patients who had experienced shingles gave responses with the highest WTP per
QALY values. Patients who had experienced PHN gave the lowest values, and
community members gave values intermediate to the shingles and PHN groups. In
multivariate models that evaluated the effects of pain and duration of the
hypothetical zoster scenario, lower duration was associated with higher WTP per
QALY. This effect appeared to be due to people increasing the amounts of time
they would be willing to trade as duration increased, without proportional
increases in the amounts of money they would be willing to pay. CONCLUSIONS:
Community members and patients gave mean WTP per QALY values that varied
significantly based on age, sex, socioeconomic status, experience with shingles
and duration of the health state evaluated. The variability in WTP per QALY
suggests that it may be difficult to define a unitary threshold of dollars per
QALY for policy making based on cost-effectiveness analyses.

PMID: 19908925 [PubMed - in process]