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]