1. 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] 2. 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] 3. 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] 4. 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 Feb 18;301(7):774-5. JAMA. 2009 Nov 4;302(17):1862; author reply 1862-3. JAMA. 2009 Jul 1;302(1):73-80. PMID: 20103745 [PubMed - indexed for MEDLINE] 5. 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] 6. 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 Sørensen 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 Sørensen 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 Sørensen 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, Mäurer 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] 7. 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] 8. 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 - indexed for MEDLINE] 9. 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] 10. 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] 11. 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] 12. Ann Acad Med Singapore. 2009 Nov;38(11):1004-6. Efficacy of limited-duration spinal cord stimulation for subacute postherpetic neuralgia. Iseki M, Morita Y, Nakamura Y, Ifuku M, Komatsu S. Juntendo University School of Medicine, Department of Anesthesiology and Pain Medicine, Tokyo, Japan. m_iseki@mbr.nifty.com Excellent outcomes were achieved with spinal cord stimulation (SCS) for 7 to 10 days on 2 patients who developed postherpetic neuralgia. Both patients were within 2 to 3 months of the onset of the condition, and nerve blocks provided only temporary pain relief and drug therapies had poor efficacy. The authors believe that limited-duration SCS for subacute postherpetic neuralgia is a useful treatment approach that may prevent the pain from progressing to chronic postherpetic neuralgia. PMID: 19956824 [PubMed - indexed for MEDLINE] 13. Joint Bone Spine. 2009 Dec;76(6):724-5. Zoster cruralgia in a pregnant woman. Daïen CI, Cohen JD, Jorgensen C. PMID: 19945328 [PubMed - indexed for MEDLINE] 14. 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] 15. 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] 16. 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] 17. 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] 18. 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] 19. 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] 20. 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]